Ohio Revised Code Search

...No individual shall be denied eligibility for the medicaid buy-in for workers with disabilities program on the basis that the individual receives services under a home and community-based services medicaid waiver component.

...individual ceases to have earnings from employment or to be an employed individual with a medically improved disability due to ceasing to be employed if the individual continues to meet all other eligibility requirements for the program.

...If the United States secretary of health and human services requires that a provision of the medicaid buy-in for workers with disabilities program be changed or removed in order for the secretary to approve the program or to avoid an extended delay in the secretary's approval, the medicaid director shall make the change or removal. The change or removal may cause the medicaid buy-in for workers with disabilitie...

...(A) The medicaid director shall adopt rules under section 5163.02 of the Revised Code as necessary to implement the medicaid buy-in for workers with disabilities program. The rules shall do all of the following: (1) Specify assets, asset values, and amounts to be disregarded in determining asset and income eligibility limits for the program; (2) Establish meanings for the terms "earned income," "health insurance...

...tion 1920 of the "Social Security Act," 42 U.S.C. 1396r-1, to make ambulatory prenatal care available to pregnant women under the medicaid program during presumptive eligibility periods. ( 2) "Qualified provider" has the same meaning as in section 1920(b)(2) of the "Social Security Act," 42 U.S.C. 1396r-1(b)(2). (B) The medicaid director shall implement the presumptive eligibility for pregnant women option. Any en...

...(l)(2)(B) of the "Social Security Act," 42 U.S.C. 1396d(l)(2)(B). (3) "Federally qualified health center look-alike" has the same meaning as in section 3701.047 of the Revised Code. (4) "Presumptive eligibility for children option" means the option available under section 1920A of the "Social Security Act," 42 U.S.C. 1396r-1a, to make medical assistance with respect to health care items and services available to ...

...(A) As used in this section: (1) "Presumptive eligibility error rate" means the rate at which a qualified entity or qualified provider deems an individual presumptively eligible for medicaid under sections 5163.10 to 5163.102 of the Revised Code when the individual is ineligible for the medicaid program. (2) "Qualified entity" has the same meaning as in section 5163.101 of the Revised Code. (3) "Qualified pr...

...As used in this section, "presumptive eligibility error rate" has the same meaning as in section 5163.103 of the Revised Code. Quarterly, the department of medicaid shall report to the general assembly the presumptive eligibility error rate for presumptive eligibility determinations made during the previous quarter. Reports made under this section shall be submitted to the general assembly in accordance with sectio...

...To the extent permissible under federal law, the department of medicaid shall redetermine the eligibility of members of the expansion eligibility group for medicaid benefits every six months.

...If a medicaid recipient is the beneficiary of a trust created pursuant to section 5815.28 of the Revised Code, then, notwithstanding any contrary provision of this chapter or of a rule adopted under section 5163.02 of the Revised Code, divisions (C) and (D) of that section shall apply in determining the assets or resources of the recipient, the recipient's estate, the settlor, or the settlor's estate and to cla...

...d supplant or replace medicaid or other public assistance; (b) A provision that prohibits the trustee from making payments that would impact or have an effect on the applicant's or recipient's right, ability, or opportunity to receive medicaid or other public assistance; (c) A provision that attempts to prevent the trust or its corpus or principal from being a resource available to the applicant or recipient. (...

...(A) The general assembly hereby finds that the state has an insurable interest in medicaid recipients because of the state's statutory right to recover from the estate of a recipient state funds used to provide the recipient with medicaid services. (B) As used in this section: (1) "Beneficiary" means the person or entity designated in a life insurance policy to receive the proceeds of the policy on the death...

... Security Act," section 1915(c) or (d), 42 U.S.C. 1396n(c) or (d). (3) "Institutionalized individual" means a resident of a nursing facility, an inpatient in a medical institution for whom a payment is made based on a level of care provided in a nursing facility, or an individual described in the "Social Security Act," section 1902(a)(10)(A)(ii)(VI), 42 U.S.C. 1396a(a)(10)(A)(ii)(VI). (4) "Look-back date" means t...

... the "Social Security Act," section 1614, 42 U.S.C. 1382c. (c) The child is financially dependent on the individual for housing as determined in accordance with rules adopted under section 5163.02 of the Revised Code. (3) The individual's sibling if the sibling has a verified equity interest in the real property and resided in the real property for at least one year immediately before the date the individual ...

...r the "Social Security Act," section 1614, 42 U.S.C. 1382c, considered blind or disabled. (2) The individual qualifies, pursuant to the process established under division (C) of this section, for a waiver of this section due to a demonstrated hardship. (C) The director shall establish a process by which individuals may obtain a waiver of this section due to a demonstrated hardship. The process shall be consist...

..."Social Security Act," section 1902(q), 42 U.S.C. 1396a(q). (B) In the case of a resident of a nursing facility, the monthly personal needs allowance shall be not less than fifty dollars for an individual resident and not less than one hundred dollars for a married couple if both spouses are residents of a nursing facility and their incomes are considered available to each other in determining eligibility. (C) In t...

...rollment for each county department. (4) Direct any county department of job and family services whose rate of enrollment of potentially eligible enrollees in the component is below acceptable levels established under division (A)(3) of this section to implement corrective action. Corrective action may include but is not limited to any one or more of the following: (a) Establishing formal referral and outreac...

... of the person from the confinement. (4) Except as provided in division (C) of this section, the person shall not be required to reapply or undergo a redetermination of eligibility for medicaid when the suspension described in division (B)(1) of this section ends. (C) A person may be disenrolled from medicaid any time after the suspension described in division (B)(1) of this section ends if the person is no l...

...ication; (3) Employment and wages; (4) Lottery winnings; (5) Residency verification including residency relating to concurrent enrollment in medicaid programs in other states; (6) Household composition; (7) Medicaid enrollee incarceration status; (8) Third-party liability verification; (9) Asset verification; (10) Any other records or systems the department considers appropriate in order to strengthen...

...Clean claim" has the same meaning as in 42 C.F.R. 447.45(b). (D) "Community behavioral health services" means both of the following: (1) Alcohol and drug addiction services provided by a community addiction services provider, as defined in section 5119.01 of the Revised Code; (2) Mental health services provided by a community mental health services provider, as defined in section 5119.01 of the Revised Code. ...

...(A) The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the Revised Code. (B) The rules shall establish all of the following: (1) The amount, duration, and scope of the medicaid services covered by the medicaid program; (2) The medicaid payment rate for each medicaid service or, in lieu of the rate, the method by which the ra...

...(A) The medicaid program shall cover all mandatory services. (B) The medicaid program shall cover all of the optional services that state statutes require the medicaid program to cover. (C) The medicaid program may cover any of the optional services to which either of the following applies: (1) State statutes expressly permit the medicaid program to cover the optional service; (2) State statutes do not addr...

...ional therapist licensed under section 4755.08 of the Revised Code. Coverage shall not be limited to services provided in a hospital or nursing facility. Any licensed occupational therapist may enter into a provider agreement with the department of medicaid to provide occupational therapy services under the medicaid program.

...ber" has the same meaning as in section 4729.01 of the Revised Code, but does not include a dentist, optometrist, or veterinarian. (2) "Prior authorization requirement" means any practice in which coverage of a health care service, device, or drug is dependent upon a recipient or health care practitioner obtaining approval from the medicaid program prior to the service, device, or drug being performed, received, or...

... hospital or other inpatient setting; (4) Authorize a certified nurse-midwife to practice beyond the authority to practice nurse-midwifery in accordance with Chapter 4723. of the Revised Code; (5) Establish minimum standards of medical diagnosis, care, or treatment for inpatient or follow-up care for a mother or newborn. A deviation from the care required to be covered under this section shall not, on the basis of ...