Ohio Revised Code Search

...(A) As used in this section, "employee" means a management employee or superintendent of a county board of developmental disabilities. (B) An employee may be removed, suspended, or demoted in accordance with this section for violation of written rules set forth by the board or for incompetency, inefficiency, dishonesty, drunkenness, immoral conduct, insubordination, discourteous treatment of the public, neglect of...

...The department of youth services shall adopt rules prescribing the minimum standards of construction for a school, forestry camp, or other facility established under section 2151.65 of the Revised Code for which financial assistance may be granted to assist in defraying the cost of the construction of the school, forestry camp, or other facility. If an application for that financial assistance is filed with the depar...

...(A) All officers shall receive for services performed under sections 515.01 to 515.16 of the Revised Code the same fees allowed for other similar services. The township fiscal officer shall receive for the fiscal officer's services the sum of fifty cents from each lot or land owner for whom a notice is prepared and the sum of fifty cents for each annual assessment certified to the county auditor. All payment...

...(A) The public children services agency shall have the capacity possessed by natural persons to institute proceedings in any court. (B) When appointed by the probate court exercising jurisdiction in adoption proceedings, the executive director may act as next friend of any child and perform the duties of such next friend. (C) When appointed by the probate court, in lieu of a guardian, in accordance with section 211...

...(A) The department of medicaid may conduct any audits or investigations that are necessary in the performance of the department's duties, and to that end, the department has the same power as a judge of a county court to administer oaths and to enforce the attendance and testimony of witnesses and the production of books or papers. The department shall keep a record of the department's audits and investigatio...

...(A) As used in this section, "business day" means any day of the week excluding Saturday, Sunday, and a legal holiday, as defined in section 1.14 of the Revised Code. (B) Subject to divisions (C) and (D) of this section, a third party shall do all of the following: (1) Accept the department of medicaid's right of recovery under section 5160.37 of the Revised Code and the assignment of rights to the department t...

...(A) As used in this section: (1) "State directed payment program" means a payment program authorized by the United States centers for medicare and medicaid services under 42 C.F.R. 438.6(c). (2) "Preprint" means a form created by the United States centers for medicare and medicaid services to request approval of a state directed payment program, as required under 42 C.F.R. 438.6(c). (B)(1) Except as provided in...

...(A) The health care/medicaid support and recoveries fund is hereby created in the state treasury. All of the following shall be credited to the fund: (1) Except as otherwise provided by statute or as authorized by the controlling board, the nonfederal share of all medicaid-related revenues, collections, and recoveries; (2) Federal reimbursement received for payment adjustments made pursuant to section 1923 of t...

...(A) A provider of medical services licensed, accredited, or certified under Chapter 3721., 3727., 4715., 4725., 4731., 4732., 4734., 4747., 4753., 4755., 4757., or 4779. of the Revised Code shall provide in writing, before products, services, or procedures are provided, a reasonable, good-faith estimate of all of the following for the provider's non-emergency products, services, or procedures: (1) The amount the pro...

...(A) As used in this section, "rapid whole genome sequencing" means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes, and includes patient-only whole genome sequencing and duo and trio whole genome sequencing of the patient and biological parent or parents. (B) Beginning one year after the effecti...

...(A) The medicaid director may do the following for any reason permitted or required by federal law and when the director determines that the action is in the best interests of medicaid recipients or the state: (1) Deny, refuse to revalidate, suspend, or terminate a provider agreement; (2) Exclude an individual, provider of services or goods, or other entity from participation in the medicaid program. (B) No ...

...(A) As used in this section: (1) "Criminal records check" has the same meaning as in section 109.572 of the Revised Code. (2) "Disqualifying offense" means any of the offenses listed or described in divisions (A)(3)(a) to (e) of section 109.572 of the Revised Code. (3) "Owner" means a person who has an ownership interest in a medicaid provider in an amount designated in rules authorized by this section. (...

...(A) As used in this section: "Anniversary date" means the effective date of the provider agreement relating to the independent provider. "Applicant" means a person who has applied for a provider agreement to provide home and community-based services as an independent provider under a home and community-based medicaid waiver component administered by the department of medicaid. "Criminal records check" has th...

...(A) As used in this section, "owner" means any person having at least five per cent ownership in a medicaid provider. (B)(1) No medicaid provider shall do any of the following: (a) By deception, obtain or attempt to obtain payments under the medicaid program to which the provider is not entitled pursuant to the provider's provider agreement, or the rules of the federal government or the medicaid director relati...

...(A) As used in this section: (1) "Credible allegation of fraud" has the same meaning as in 42 C.F.R. 455.2, except that for purposes of this section any reference in that regulation to the "state" or the "state medicaid agency" means the department of medicaid. (2) "Disqualifying indictment" means an indictment of a medicaid provider or its officer, authorized agent, associate, manager, employee, or, if the pro...

...Medicaid payments for freestanding medical laboratory charges shall not exceed the customary and usual fee for laboratory profiles.

...(A) As used in this section, "state maximum allowable cost" means the per unit amount the medicaid program pays a terminal distributor of dangerous drugs for a prescribed drug included in the state maximum allowable cost program established under division (B) of this section. "State maximum allowable cost" excludes dispensing fees and copayments, coinsurance, or other cost-sharing charges, if any. (B) Subject to se...

...(A) If the medicaid director implements the integrated care delivery system and except as provided in division (C) of this section, the director shall annually evaluate all of the following: (1) The health outcomes of ICDS participants; (2) How changes to the administration of the ICDS affect all of the following: (a) Claims processing; (b) The appeals process; (c) The number of reassessments requested; (d...

...As used in this section, "advanced diagnostic imaging services" means magnetic resonance imaging services, computed tomography services, positron emission tomography services, cardiac nuclear medicine services, and similar imaging services. The department of medicaid shall implement evidence-based, best practice guidelines or protocols and decision support tools for advanced diagnostic imaging services covere...

...A nursing facility resident has a cause of action against a nursing facility provider for breach of the provider agreement obligations or other duties imposed by section 5165.08 of the Revised Code. The action may be commenced by the resident, or on the resident's behalf by the resident's sponsor or a residents' rights advocate, by the filing of a civil action in the court of common pleas of the county in which...

...(A) On receipt of a written notice under section 5165.50 of the Revised Code of a facility closure or voluntary withdrawal of participation, on receipt of a written notice under section 5165.51 of the Revised Code of a change of operator, or on the effective date of an involuntary termination, the department of medicaid shall estimate the amount of any overpayments made under the medicaid program to the exiting opera...

...(A) As used in sections 5166.40 to 5166.409 of the Revised Code: (1) "Adult" means an individual who is at least eighteen years of age. (2) "Buckeye account" means a modified health savings account established under section 5166.402 of the Revised Code. (3) "Contribution" means the amounts that an individual contributes to the individual's buckeye account and are contributed to the account on the individual's beha...

...(A) A healthy Ohio program participant's participation in the program shall cease if any of the following applies: (1) Unless the participant is pregnant, a monthly installment payment to the participant's buckeye account is sixty days late. (2) The participant fails to submit documentation needed for a redetermination of the participant's eligibility for medicaid before the sixty-first day after the documentation ...

...If a healthy Ohio program participant exhausts the annual or lifetime payout limits specified in division (D) of section 5166.401 of the Revised Code, the participant shall be transferred to the fee-for-service component of medicaid or the care management system. A participant who exhausts the annual payout limit for a year shall resume participation in the healthy Ohio program at the beginning of the immediately fol...

...(A) The state pharmacy benefit manager shall, on request from the department of medicaid, disclose to the department all sources of payment it receives for prescribed drugs, including any financial benefits such as drug rebates, discounts, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other payments related to services provided for the medicaid managed care organization. (B) Each medicaid manage...