Ohio Revised Code Search

...A nursing facility operator may enter into provider agreements for more than one nursing facility.

...e to persons with whom the provider has contracted to provide continuing care; (3) If the nursing facility is a county home organized under Chapter 5155. of the Revised Code, admitting residents exclusively from the county in which the county home is located; (4) Retaining residents who have resided in the provider's nursing facility for not less than one year as private pay patients and who subsequently become med...

...nalties, notification for correction of contract violations, and history of deficiencies. (B) Division (A)(3) of this section does not prohibit a nursing facility provider from excluding one or more parts of the nursing facility from the provider agreement pursuant to division (B)(1) of section 5165.08 of the Revised Code.

...ng documents, and fully executed sales contracts and any other supporting documents culminating in the change of operator; (C) The method by which the forms and documents identified in division (B) of this section are to be provided to the department.

...force the sections directly or through contracting agencies. The department and agencies shall enforce the sections in accordance with the requirements of the "Social Security Act," sections 1819 and 1919, 42 U.S.C. 1395i-3 and 1396r, that apply to nursing facilities; with regulations, guidelines, and procedures adopted by the United States secretary of health and human services for the enforcement of those sec...

...action by the department of medicaid or contracting agency under this chapter or is an action by any department or agency of the state to enforce this chapter or another chapter of the Revised Code; (B) An advertisement, unless the advertisement includes all of the following: (1) The date the survey was conducted; (2) A statement that the department of health conducts a survey of all nursing facilities at least on...

...ho currently has a consulting or other contract with the department or the facility, shall be appointed as a monitor under this section. Every monitor appointed under this section shall have the professional qualifications necessary to monitor correction of the finding or elimination of the emergency.

...nding, the department of medicaid or a contracting agency may, subject to sections 5165.82 and 5165.83 of the Revised Code, impose one or more of the following remedies: (A) Do either of the following: (1) Issue an order denying medicaid payments to the facility for all medicaid eligible residents admitted after the effective date of the order; (2) Impose a fine. (B) Issue an order denying medicaid payments...

...posed, the department of medicaid or a contracting agency shall do both of the following: (1) Impose the remedies that are most likely to achieve correction of deficiencies, encourage sustained compliance with certification requirements, and protect the health, safety, and rights of facility residents, but that are not directed at punishment of the facility; (2) Consider all of the following: (a) The presenc...

...e time the department of medicaid or a contracting agency, under section 5165.71, 5165.72, or 5165.77 of the Revised Code, issues an order terminating a nursing facility's participation in the medicaid program, the department or agency may also impose a fine, in accordance with sections 5165.72 to 5165.74 and 5165.83 of the Revised Code, to be collected in the event the termination order does not take effect. T...

... quality improvement organization under contract with the United States secretary of health and human services to carry out in this state the functions described in section 1154 of the "Social Security Act," 42 U.S.C. 1320c-3.

...a state agency or political subdivision contracts with the department under section 5162.35 of the Revised Code to administer the component, that state agency or political subdivision. "Care management system" has the same meaning as in section 5167.01 of the Revised Code. "Dual eligible individual" has the same meaning as in section 5160.01 of the Revised Code. "Enrollee" has the same meaning as in section ...

... state agency or political subdivision contracts with the department under section 5162.35 of the Revised Code to administer a home and community-based services medicaid waiver component and approves, modifies, or denies a written plan of care or individual service plan pursuant to the agency's or subdivision's administration of the component, the department may review the agency's or subdivision's approval, m...

... to the extent, if any, provided by the contract required by section 5166.21 of the Revised Code regarding the component.

...to the extent, if any, provided by the contract required by section 5166.21 of the Revised Code regarding the component.

...ed by a managed care organization under contract with the department of medicaid. All of the following apply to the health plan: (A) It shall cover physician, hospital inpatient, hospital outpatient, pregnancy-related, mental health, pharmaceutical, laboratory, and other health care services the medicaid director determines necessary. (B) It shall not begin to pay for any services it covers until the amount of the ...

...rships between relevant groups and may contract directly or subcontract with the state to provide care coordination and other services to the medicaid recipients under twenty-one years of age described in this division who are permitted or required to participate in the care management system. (C)(1) To be recognized by the department as a pediatric accountable care organization, an entity shall meet the stand...

...ed care organizations perform under the contracts entered into under section 5167.10 of the Revised Code. The performance metrics may include financial incentives and penalties. The department shall make available on its internet web site the metrics the department uses to determine how well medicaid managed care organizations perform. The department shall update its internet web site each quarter to reflect any ch...

...Each medicaid managed care organization shall provide a grievance process for the organization's enrollees in accordance with 42 C.F.R. 438, subpart F.

...When contracting under section 5167.10 of the Revised Code with a medicaid managed care organization, the department of medicaid shall require the organization to comply with section 5164.061 of the Revised Code as if the organization were the department. This section does not limit the authority of a medicaid managed care organization to implement measures designed to improve quality and reduce costs.

...2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the amounts (less any payments for indirect costs of medical education and direct costs of graduate medical education) that the provider could collect if the enrollee received medicaid other than through enrollment in a medicaid MCO plan. An agreement entered in...

...ts, the department shall include in the contracts entered into with medicaid managed care organizations under section 5167.10 of the Revised Code terms the department determines are reasonable to establish limits on such recoupment efforts. The terms shall include exceptions for cases of fraud and other types of deception.

...e master state pharmacy benefit manager contract under section 5167.24 of the Revised Code or section 5167.241 of the Revised Code. Whoever violates those sections is subject to a civil penalty in an amount to be determined by the medicaid director.

...records for each hospital with which it contracts, including records regarding the cost to the hospital of providing hospital services for the organization, payments made by the organization to the hospital for the services, utilization of hospital services by the organization's enrollees, and other utilization data required by the department.

... Code. The department may specify in a contract with a medicaid managed care organization the amounts of financial incentive awards, methodology for distributing awards, types of awards, and standards for administration by the department.