Ohio Revised Code Search

...The medicaid program shall not cover prescribed drugs for treatment of erectile dysfunction.

...The departments of developmental disabilities and medicaid may approve, reduce, deny, or terminate a medicaid service included in the individual service plan developed for a medicaid recipient with a developmental disability who is eligible for medicaid case management services. If either department approves, reduces, denies, or terminates a service, that department shall timely notify the medicaid recipient that the...

...The department of medicaid shall establish a combination of written and oral methods designed to provide information about healthcheck to all persons eligible for the program or their parents or guardians. The department shall ensure that its methods of providing information are effective. Each entity that distributes or accepts applications for medicaid shall prominently display a notice that complies with t...

...Not later than December 31, 2018, the department of medicaid shall develop and implement revisions to the system by which persons and government entities become and remain medicaid providers so that there is a single system of records for the system and the persons and government entities do not have to submit duplicate data to the state to become or remain medicaid providers for any component or aspect of a componen...

...rector may adopt rules under section 5164.02 of the Revised Code as necessary to implement this section. Any rules adopted shall be consistent with the requirements that apply to medicare advantage organizations under 42 C.F.R. 422.204.

...No person or government entity may participate in the medicaid program as a medicaid provider without a valid provider agreement with the department of medicaid.

...ce" has the same meaning as in section 4731.65 of the Revised Code. (B) The department of medicaid shall establish a process by which a physician assistant may enter into a provider agreement. (C)(1) Subject to division (C)(2) of this section, a claim for medicaid payment for a medicaid service provided by a physician assistant to a medicaid recipient may be submitted by the physician assistant who provided t...

... screening requirements of subpart E of 42 C.F.R. Part 455 and except as provided in division (B) of this section, the department of medicaid shall collect an application fee from a medicaid provider before doing any of the following: (1) Entering into a provider agreement with a medicaid provider that seeks initial enrollment as a provider; (2) Entering into a provider agreement with a former medicaid provider tha...

...tor shall adopt rules under section 5164.02 of the Revised Code as necessary to implement this section. The rules shall be consistent with subpart E of 42 C.F.R. Part 455 and include a process for revalidating medicaid providers' continued enrollments as providers. All of the following apply to the revalidation process: (1) The department shall refuse to revalidate a provider's provider agreement when the prov...

...tor shall adopt rules under section 5164.02 of the Revised Code governing the process for requesting a reconsideration. (D) Nothing in this section limits the applicability of section 5164.38 of the Revised Code to a medicaid provider.

...ucted pursuant to this section is not a public record for the purposes of section 149.43 of the Revised Code and shall not be made available to any person other than the following: (1) The person who is the subject of the criminal records check or the person's representative; (2) The medicaid director and the staff of the department who are involved in the administration of the medicaid program; (3) The depa...

...lic record for the purposes of section 149.43 of the Revised Code. Such a report or notice shall not be made available to any person other than the following: (1) The person who is the subject of the criminal records check or the person's representative; (2) The medicaid director and the staff of the department who are involved in the administration of the medicaid program; (3) The department's designee; ...

...equest made under this section is not a public record for the purposes of section 149.43 of the Revised Code and shall not be made available to any person other than the following: (1) The applicant or employee who is the subject of the criminal records check or the representative of the applicant or employee; (2) The chief administrator of the waiver agency that requires the applicant or employee to request th...

...r real estate mortgages under section 1343.01 of the Revised Code on the date the payment was made to the provider for a period determined by the department, not to exceed the period from the date upon which payment was made, to the date upon which repayment is made to the state; (2) Payment of an amount equal to three times the amount of any excess payments; (3) Payment of a sum of not less than five thousand ...

...lowing apply: (i) The act would be a felony or misdemeanor under the laws of this state or the jurisdiction within which the act occurred. (ii) The act relates to or results from furnishing or billing for medicaid services under the medicaid program or relates to or results from performing management or administrative services relating to furnishing medicaid services under the medicaid program. (b) The indic...

...ting the provider agreement. Section 5164.38 of the Revised Code applies to the termination of the provider agreement. (D) The suspension of a medicaid provider's provider agreement and medicaid payments shall cease at the earliest of the following: (1) The department's failure to provide a notice required by division (B) of this section by the time specified in that division; (2) The department rescinds its no...

...ished in rules authorized by section 5164.32 of the Revised Code. (B) This section does not apply to either of the following: (1) Any action taken or decision made by the department of medicaid with respect to entering into or refusing to enter into a contract with a managed care organization pursuant to section 5167.10 of the Revised Code; (2) Any action taken by the department under division (D)(2) of sect...

...epartment of medicaid under section 5164.38 or 5164.57 of the Revised Code or any other state statute governing the medicaid program that requires the department to give notice of an opportunity for a hearing in accordance with Chapter 119. of the Revised Code, if the department gives notice of the opportunity for a hearing but the medicaid provider or other entity subject to the notice does not request a hear...

...ome health services benefit pursuant to 42 C.F.R. 440.70(b)(2); (b) Home care attendant services covered by a participating medicaid waiver component, as defined in section 5166.30 of the Revised Code; (c) Any of the following covered by a home and community-based services medicaid waiver component: (i) Personal care aide services; (ii) Homemaker/personal care services; (iii) Community inclusion services. ...

...er tapes of such claims for payment; (4) In addition to audits which may be conducted by the department and by the auditor of state, make audits of providers and the claims of medicaid providers according to the standards set forth in the contract; (5) Assist medicaid providers in the development of procedures relating to utilization practices, make studies of the effectiveness of such procedures and methods ...

...A medicaid managed care organization; (4) Any other medicaid provider or type of medicaid provider designated in rules adopted under section 5162.02 of the Revised Code. (D) The department shall not process a medicaid claim submitted on or after January 1, 2013, unless the claim is submitted through an electronic claims submission process in accordance with this section.

...12 of the Revised Code, be considered a public entity and the director shall seek federal financial participation for costs incurred by OCHSPS in performing the service or services.

...Not less than once each year and in accordance with all state and federal laws governing the confidentiality of patient-identifying information, the department of medicaid shall make summary data regarding perinatal services available on request to local organizations concerned with infant mortality reduction initiatives and recipients of grants administered by the division of family and community health services in...

...The medicaid director may implement a system under which medicaid payments for medicaid services are made to an organization on behalf of medicaid providers. The system may not provide for an organization to receive an amount that exceeds, in aggregate, the amount the medicaid program would have paid directly to medicaid providers if not for this section.

...The department of medicaid may conduct final fiscal audits of medicaid providers in accordance with the applicable requirements set forth in federal laws and regulations and determine any amounts the provider may owe the state. When conducting final fiscal audits, the department shall consider generally accepted auditing standards, which include the use of statistical sampling.