Ohio Revised Code Search

...A consumer who is an adult may select an individual to act on the consumer's behalf for purposes regarding home care attendant services by submitting a written notice of the consumer's selection of an authorized representative to the appropriate director. The notice shall specifically identify the individual the consumer selects as authorized representative and may limit what the authorized representative may d...

...If the department of medicaid terminates the 209(b) option, the department shall establish a medicaid waiver component under which an individual who has cystic fibrosis and is enrolled in the program for children and youth with special health care needs by the department of health under section 3701.023 of the Revised Code or the program the department of health administers pursuant to division (G) of that section ma...

...r an occupational training program; (4) Be participating in an alcohol and drug addiction treatment program; (5) Have intensive physical health care needs or serious mental illness. (B) Not earlier than February 1, 2025, and not later than March 1, 2025, the director shall seek approval from the United States centers for medicare and medicaid services to implement the medicaid waiver component described in t...

...(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 healthy Ohio program participant shall enroll in a comprehensive health plan offered 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...

...ection and division (A) of section 5166.404 of the Revised Code; (b) Contributions made by the participant and on the participant's behalf under divisions (C) and (D) of this section. (2) A buckeye account shall not have more than ten thousand dollars in it at one time. (B) Subject to division (A)(2) of this section, one thousand dollars of medicaid funds shall be deposited each year into the buckeye account of a ...

...ents under division (C) of section 5166.401 of the Revised Code; (3) Subject to rules authorized by section 5166.409 of the Revised Code, the costs of health care services that are medically necessary for the participant but not covered by the health plan. (B)(1) A healthy Ohio program participant's debit swipe card shall be credited with one point for each of the following: (a) Each dollar of medicaid funds depos...

...ions under division (C) of section 5166.402 of the Revised Code to be made by electronic funds transfers from the participant's checking or savings account. Twenty points shall be deducted from the participant's card if the participant terminates the electronic funds transfers. (C) The director may award up to two hundred points annually to a healthy Ohio program participant who achieves health care goals. The point...

...d in the expansion eligibility group. (4) The participant becomes a ward of the state. (5) The participant ceases to be eligible for medicaid. (6) The participant exhausts the annual or lifetime payout limit specified in division (D) of section 5166.401 of the Revised Code. (7) The participant requests that the participant's participation be terminated. (B) A healthy Ohio program participant who ceases to partic...

...ecified 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 following year if division (B) of section 5166.40 of the Revised Code continues to apply ...

...(A) If a healthy Ohio program participant ceases to qualify for medicaid due to increased family countable income and purchases a health insurance policy or obtains health care coverage under an eligible employer-sponsored health plan, the amount remaining in the former participant's buckeye account shall be transferred to an account to be known as a bridge account. The amount so transferred may be used only to pay f...

...Each county department of job and family services shall offer to refer to a local board each healthy Ohio program participant who resides in the county served by the county department and is either unemployed or employed for less than an average of twenty hours per week. The referral shall include information about the workforce development activities available from the local board. A participant may refuse to accept...

...e of division (F)(1)(a) of section 5166.402 of the Revised Code, establish requirements regarding preventative health services for healthy Ohio program participants. The requirements may differ for participants of different ages and genders. (B) For the purpose of division (G)(2) of section 5166.402 of the Revised Code, authorize additional uses of a buckeye account and establish the means for using the account for ...

...903(v)(2) of the "Social Security Act," 42 U.S.C. 1396b(v)(2); (3) Eligible for the refugee medical assistance program administered pursuant to section 5160.50 of the Revised Code.

...described in section 340B(a)(4) of the "Public Health Service Act," 42 U.S.C. 256b(a)(4) and includes any pharmacy under contract with the entity to dispense drugs on behalf of the entity. (B) "Affiliated company" means an entity, including a third-party payer or specialty pharmacy, with common ownership, members of a board of directors, or managers, or that is a parent company, subsidiary company, jointly held com...

...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.

...ode. Except as provided in section 5166.406 of the Revised Code, no medicaid recipient participating in the healthy Ohio program established under section 5166.40 of the Revised Code shall participate in the system. The general assembly's authorization through the enactment of legislation is needed before home and community-based services available under a medicaid waiver component or nursing facility services are ...

... Protection and Affordable Care Act," 124 Stat. 325 (2010) and the "Social Security Act," section 1895, 42 U.S.C. 1395jjj, the regulations adopted pursuant to those sections, and the laws of this state, the department shall not require that an entity be a health insuring corporation as a condition of receiving the department's recognition. (2) Any of the following entities may receive the department's recognit...

...The department of medicaid shall include alcohol, drug addiction, and mental health services covered by medicaid in the care management system.

...The department of medicaid may include prescribed drugs covered by the medicaid program in the care management system.

...macist services described in section 5164.14 of the Revised Code, the department of medicaid may include the services in the care management system.

...The department of medicaid may enter into contracts with managed care organizations under which the organizations are authorized to provide, or arrange for the provision of, health care services to medicaid recipients who are required or permitted to participate in the care management system.

...(A) Subject to division (B) of this section, the department of medicaid or its actuary shall base the hospital inpatient capital payment portion of the payment made to a medicaid managed care organization on data for services provided to all of the organization's enrollees, as reported by hospitals on relevant cost reports submitted pursuant to rules adopted under section 5167.02 of the Revised Code. (B) The hospit...

...In addition to the managed care performance payment program created under section 5167.30 of the Revised Code, the department of medicaid shall establish performance metrics that will be used to evaluate and compare how medicaid managed 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 de...

...nization's enrollees in accordance with 42 C.F.R. 438, subpart F.