Ohio Revised Code Search

...pose requirements on the department of medicaid, when it has been assigned the rights of an individual who is eligible for medicaid and who is covered under a health care policy, contract, or plan issued by the health insurer, that are different from the requirements applicable to an agent or assignee of any other individual so covered.

...n. (2) The credentialing process for a medicaid managed care plan starts when the provider submits a credentialing form and the provider's national provider number issued by the centers for medicare and medicaid services. (3) The requirement that the credentialing process be completed within the ninety-day period specified in division (C)(1) of this section does not apply to a contracting entity if a provi...

...and 5108. of the Revised Code; (3) The medicaid program; (4) The supplemental nutrition assistance program pursuant to the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.; (5) Any Ohio program under a plan approved under Title I, X, XIV, or XVI of the "Social Security Act." Wage information provided by employers to the director shall be furnished to the income and eligibility verification system. Such ...

... in a home and community-based services medicaid waiver component, as defined in section 5166.01 of the Revised Code; (16) A facility operated by the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code; (17) A women, infants, and children clinic; (18) A mobile dental facility, as defined in section 4715.70 of t...

... this section, "340B covered entity, " "medicaid managed care organization, " and "third-party administrator" have the same meanings as in section 5167.01 of the Revised Code. (B) A contract between a terminal distributor of dangerous drugs and a 340B covered entity shall require the terminal distributor to comply with division (C) of this section. (C) When paying a 340B covered entity for a dangerous drug dispen...

...urred. The board also shall notify the medicaid director if the board determines that the violation may have been committed by a provider of services under a program administered by the department of medicaid.

... violation. If a refund is owed to the medicaid program, the auditor of state also shall report the amount to the department of medicaid. The state medical board also may implement procedures to detect violations of section 4731.66 or 4731.69 of the Revised Code.

...refund or reconciliation related to the medicaid program, the department shall transfer the money to the department of medicaid for deposit into the refunds and reconciliation fund created under section 5162.65 of the Revised Code.

...Title IV-E and costs reimbursable under medicaid; (2) Procedures to monitor cost reports submitted by the agencies or entities. (B) The procedures established under division (A)(2) of this section shall be implemented not later than October 1, 2003. The procedures shall be used to do both of the following: (1) Determine which of the costs are reimbursable under Title IV-E; (2) Ensure that costs reimbursab...

...eria: (1) Under rules adopted by the medicaid director governing medicaid payments for long-term care services, the children require a skilled level of care. (2) The children require the services of a doctor of medicine or osteopathic medicine at least once a week due to the instability of their medical conditions. (3) The children require the services of a registered nurse on a daily basis. (4) The child...

...ties shall pay the nonfederal share of medicaid expenditures for medicaid case management services and home and community-based services for which no county board of developmental disabilities is required by section 5126.059 or 5126.0510 of the Revised Code to pay.

...r. The programs may include one or more medicaid waiver components that the director administers pursuant to section 5166.21 of the Revised Code. The programs may do one or more of the following: (1) Establish models that incorporate elements common to effective intervention programs and evidence-based practices in services for children with intensive behavioral needs; (2) Design a template for individualized educa...

...overnment entity's authority to provide medicaid-funded supported living is revoked or renewal of the authority is refused pursuant to section 5123.1610 of the Revised Code, neither the person or government entity nor a related party of the person or government entity may apply for authority to provide medicaid-funded supported living again earlier than the date this is five years after the date the authority is rev...

...The medicaid program shall cover ICF/IID services when all of the following apply: (A) The ICF/IID services are provided to a medicaid recipient eligible for the services. (B) The ICF/IID services are provided by an ICF/IID for which the provider has a valid provider agreement. (C) Federal financial participation is available for the ICF/IID services.

...irector of health for participation in medicaid; (2) The ICF/IID is licensed by the director of developmental disabilities as a residential facility; (3) Subject to division (B) of this section, the operator and ICF/IID comply with all applicable state and federal statutes and rules. (B) A state rule that requires an ICF/IID operator to have received approval of a plan for the proposed ICF/IID pursuant to se...

...g which the ICF/IID participated in the medicaid program. Except as provided in division (E) of this section, the cost report is due not later than ninety days after the end of the calendar year, or portion of the calendar year, that the cost report covers. (B)(1) If an ICF/IID undergoes a change of provider that the department determines, in accordance with rules adopted under section 5124.03 of the Revised Code, i...

...thorized by this section, the total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be paid for ICF/IID services that an ICF/IID not designated as an outlier ICF/IID or unit provides to a resident who meets the criteria for admission to a designated outlier ICF/IID or unit, as specified in rules authorized by section 5124.152 of the Revised Code. Instead, the provide...

...s is not required to pay the total per medicaid day payment rates determined under section 5124.15 of the Revised Code for ICF/IID services provided by developmental centers. Instead, the department may determine the medicaid payment rates for developmental centers according to the reasonable cost principles of Title XVIII.

...ties shall determine each ICF/IID's per medicaid day indirect care costs component rate. An ICF/IID's rate shall be the lesser of the individual rate determined under division (B) of this section and the maximum rate determined for the ICF/IID's peer group under division (C) of this section. (B) An ICF/IID's individual rate is the sum of the following: (1) The ICF/IID's desk-reviewed, actual, allowable, per diem ...

...ties shall determine each ICF/IID's per medicaid day other protected costs component rate. An ICF/IID's rate shall be the ICF/IID's desk-reviewed, actual, allowable, per diem other protected costs from the applicable cost report year, adjusted for inflation using the following: (A) Subject to division (B) of this section, the consumer price index for all urban consumers for nonprescription drugs and medical supplie...

...bilities shall not reduce an ICF/IID's medicaid payment rate determined under this chapter on the basis that the provider charges a lower rate to any resident who is not eligible for medicaid.

...No medicaid payment shall be made to an ICF/IID provider for the day a medicaid recipient is discharged from the ICF/IID, unless the recipient is discharged from the ICF/IID because all of the beds in the ICF/IID are converted from providing ICF/IID services to providing home and community-based services pursuant to section 5124.60 or 5124.61 of the Revised Code.

...Medicaid payments may be made for ICF/IID services provided not later than thirty days after the effective date of an involuntary termination of the ICF/IID that provides the services if the services are provided to a medicaid recipient who is eligible for the services and resided in the ICF/IID before the effective date of the involuntary termination.

... the following from the next available medicaid payment the department makes to an ICF/IID provider who continues to participate in medicaid: (1) Any amount the provider is required to refund, and any interest charged, under section 5124.41 of the Revised Code; (2) The amount of any penalty imposed on the provider under section 5124.42 of the Revised Code. (B) The department and an ICF/IID provider may enter...

...tor of the ICF/IID for purposes of the medicaid program, including medicaid payments, until the effective date of the entering operator's provider agreement if the provider agreement is entered into under section 5124.511 or 5124.512 of the Revised Code.