Ohio Revised Code Search

...le XVIII of the "Social Security Act," 42 U.S.C. 1395w-21 et seq. (b) Identify all of the following: (i) Changes in the amount of time it takes to process claims and the number of claims denied and the reasons for the changes; (ii) The impact that changes to the administration of the ICDS had on the appeals process and number of reassessments requested; (iii) The number of prior authorization denials that wer...

...The medicaid director shall select from among universally accepted claim forms used in the United States a standardized claim form for each type of medicaid provider that provides medicaid services under the integrated care delivery system. The director shall create standardized claim codes to be used on the standardized claim forms. Each medicaid provider and medicaid provider's designee that bills for medicaid serv...

...(A)(1) In addition to any other eligibility requirement of this chapter, to be eligible to serve as a personal care aide under the integrated care delivery system, an individual must successfully complete thirty hours of pre-service training acceptable to the department of medicaid. To maintain eligibility, each personal care aide must successfully complete six hours of in-service training acceptable to the depart...

...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...

...ty Act," section 1903(a)(3)(F) and (t), 42 U.S.C. 1396b(a)(3)(F) and (t), to encourage the adoption and use of electronic health record technology by medicaid providers who are identified under that federal law as eligible professionals. (B) After the department has made a determination regarding the amount of a medicaid provider's electronic health record incentive payment or the denial of an incentive paymen...

...The medicaid director shall implement within the medicaid program a system that encourages medicaid providers to provide medicaid services to medicaid recipients in culturally and linguistically appropriate manners.

...ished in rules adopted under section 5164.02 of the Revised Code. In accordance with section 5162.021 of the Revised Code, the medicaid director shall adopt rules authorizing the directors of other state agencies to adopt rules regarding the medicaid coverage of telehealth services under programs administered by the other state agencies. Any such rules adopted by the medicaid director or the directors of other stat...

...try" has the same meaning as in section 4715.43 of the Revised Code. The department of medicaid shall establish standards for medicaid payments for services provided through teledentistry. The standards shall provide coverage for services to the same extent that those services would be covered by the medicaid program if the services were provided without the use of teledentistry.

...vice organization as defined in section 4765.01 of the Revised Code. (B)(1) The medicaid director shall submit a medicaid state plan amendment to the United States centers for medicare and medicaid services seeking authorization to establish and administer a supplemental payment program to provide supplemental medicaid payments to eligible ground emergency medical transportation service providers. If approved, the...

...or is a corporation that has securities publicly traded in a marketplace, a change of one or more members of the corporation's governing body or transfer of ownership of one or more shares of the corporation's stock, if the same corporation continues to be the operator; (d) An initial public offering for which the securities and exchange commission has declared the registration statement effective, and the newly c...

...(A) Except as provided in division (B) of this section, whenever "skilled nursing facility," "intermediate care facility," or "dual skilled nursing and intermediate care facility" is referred to or designated in any statute, rule, contract, provider agreement, or other document pertaining to the medicaid program, the reference or designation is deemed to refer to a nursing facility. (B) A reference to or desi...

...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.

...(7)(G)(i) of the "Social Security Act," 42 U.S.C. 1396r(e)(7)(G)(i). (3) "Individual with a mental illness" means an individual who has a serious mental illness other than either of the following: (a) A primary diagnosis of dementia; (b) A primary diagnosis that is not a primary diagnosis of dementia and a primary diagnosis of something other than a serious mental illness. (4) "Mentally retarded individual" m...

... addiction services under section 5119.40 of the Revised Code or by the department of developmental disabilities under section 5123.021 of the Revised Code. If the individual is an applicant for or recipient of medicaid, the individual may appeal pursuant to section 5160.31 of the Revised Code. If the individual is not an applicant for or recipient of medicaid, the individual may appeal pursuant to a process t...

...consultation provided under section 173.42 of the Revised Code. To the maximum extent possible, the assessment shall be based on information from the resident assessment instrument specified in rules authorized by section 5165.191 of the Revised Code. The assessment shall also be based on criteria and procedures established in rules authorized by division (F) of this section and information provided by the pers...

...Subject to section 5165.072 of the Revised Code, an operator is eligible to enter into and retain a provider agreement for a nursing facility if all of the following apply: (A) The nursing facility is certified by the director of health for participation in medicaid; (B) The nursing facility is licensed by the director of health as a nursing home if so required by law and the operator is the licensed operator of...

...eports as required by the department; (4) Open all records relating to the costs of the nursing facility's services for inspection and audit by the department; (5) Open its premises for inspection by the department, the department of health, and any other state or local authority having authority to inspect; (6) Supply to the department such information as it requires concerning the nursing facility's services...

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

...The department of medicaid shall not revalidate a nursing facility provider agreement if the provider fails to maintain eligibility for the provider agreement as provided in section 5165.06 of the Revised Code.

...The department of medicaid shall terminate the provider agreement with a nursing facility provider that does not comply with the requirements of section 3721.071 of the Revised Code for the installation of fire extinguishing and fire alarm systems.

... 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 medicaid recipients, but refusing to accept as a resident any person who is, or may (as a resident of the nursing facility) become a medicaid recipient, if all of the following apply: (a) The provider does not refuse to retai...

...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) Except as provided in division (B) of this section, the operator of a nursing facility that elects to have the nursing facility participate in the medicaid program shall qualify all of the nursing facility's medicaid-certified beds in the medicare program. The medicaid director may adopt rules under section 5165.02 of the Revised Code to establish the time frame in which a nursing facility must comply with ...

...(A) Except as provided in division (C) of this section, each nursing facility provider shall file with the department of medicaid an annual cost report for each of the provider's nursing facilities that participate in the medicaid program. The cost report for a year shall cover the calendar year or the portion of the calendar year during which the nursing facility participated in the medicaid program. Except as...

...A nursing facility provider filing the nursing facility's cost report with the department of medicaid under section 5165.10 or 5165.522 of the Revised Code shall report as a nonreimbursable expense the cost of the nursing facility's franchise permit fee.