Ohio Revised Code Search

...The medicaid director shall provide, to a veteran who has submitted an application for the medicaid program, information about the county veterans service office that can assist with investigating and applying for benefits through the United States department of veterans affairs. As used in this section, "veteran" has the same meaning as in section 5901.01 of the Revised Code.

...The medicaid director shall implement the option authorized by the "Social Security Act," section 1931(b)(2)(C), 42 U.S.C. 1396u-1(b)(2)(C), to set the income eligibility threshold at ninety per cent of the federal poverty line for parents and caretaker relatives who are covered by the medicaid program under that section of the "Social Security Act."

...the resource eligibility limit for the medicaid buy-in for workers with disabilities program shall not exceed ten thousand dollars. (B) Each calendar year, the medicaid director shall adjust the resource eligibility limit specified in division (A) of this section by the change in the consumer price index for all items for all urban consumers for the previous calendar year, as published by the United States bu...

...ervices available to children under the medicaid program during presumptive eligibility periods. (5) "Qualified entity" has the same meaning as in section 1920A(b)(3) of the "Social Security Act," 42 U.S.C. 1396r-1a(b)(3). (B) The medicaid director shall implement the presumptive eligibility for children option. Children's hospitals, federally qualified health centers, and federally qualified health center look-al...

...y services, ICF/IID services, or other medicaid-funded long-term care services, the medicaid director may consider an aged, blind, or disabled individual's real property to not be the individual's homestead or principal place of residence once the individual has resided in a nursing facility, ICF/IID, or other medical institution for at least thirteen months. (B) Division (A) of this section does not apply to...

...for nursing facility services or other medicaid-funded long-term care services if the individual's equity interest in the individual's home exceeds five hundred thousand dollars. The medicaid director shall increase this amount effective January 1, 2011, and the first day of each year thereafter, by the percentage increase in the consumer price index for all urban consumers (all items; United States city avera...

...determining the amount of income that a medicaid recipient must apply monthly toward payment of the cost of care in a nursing facility or ICF/IID, a county department of job and family services shall deduct from the recipient's monthly income a monthly personal needs allowance in accordance with the "Social Security Act," section 1902(q), 42 U.S.C. 1396a(q). (B) In the case of a resident of a nursing facility, the m...

...r 4730. of the Revised Code. (B) The medicaid program shall cover pasteurized human donor milk and human milk fortifiers, in both hospital and home settings, for an infant whose gestationally corrected age is less than twelve months when all of the following apply: (1) A licensed health professional signs an order stating that human donor milk or human milk fortifiers are medically necessary because the infant ...

... remission. (B)(1) With respect to the medicaid program's coverage of prescribed drugs, the department of medicaid shall apply prior authorization requirements or other utilization review measures as conditions of providing coverage of an opioid analgesic prescribed for the treatment of chronic pain, except when the drug is prescribed under one of the following circumstances: (a) To an individual who is a hospice p...

...The medicaid program may cover tobacco cessation services in addition to the services that must be covered under section 5164.10 of the Revised Code or may exclude coverage of additional tobacco cessation services.

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

...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...

...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.

...on 1927(e), 42 U.S.C. 1396r-8(e). The medicaid payment for a drug that is subject to a federal upper reimbursement limit shall not exceed, in the aggregate, the federal upper reimbursement limit for the drug.

... 4729.01 of the Revised Code. (B) The medicaid director may enter into or administer an agreement or cooperative arrangement with other states to create or join a multiple-state prescription drug purchasing program for the purpose of negotiating with manufacturers of dangerous drugs to receive discounts or rebates for dangerous drugs covered by the medicaid program.

...42 U.S.C. 1396r-8(g), the department of medicaid shall establish an outpatient drug use review program to assure that prescriptions obtained by medicaid recipients are appropriate, medically necessary, and unlikely to cause adverse medical results.

...The department of medicaid shall not knowingly make a medicaid payment for a provider-preventable condition for which federal financial participation is prohibited by regulations adopted under the "Patient Protection and Affordable Care Act," section 2702, 42 U.S.C. 1396b-1.

...r that section. (B) The department of medicaid may implement a program pursuant to the "Social Security Act," section 1906, 42 U.S.C. 1396e, for the enrollment of medicaid-eligible individuals in group health plans when the department determines that enrollment is cost-effective.

...The medicaid director shall establish a qualified state long-term care insurance partnership program consistent with the definition of that term in the "Social Security Act," section 1917(b)(1)(C)(iii), 42 U.S.C. 1396p(b)(1)(C)(iii). An individual participating in the program who is subject to the medicaid estate recovery program instituted under section 5162.21 of the Revised Code shall be eligible for the re...

...The department of medicaid may require county departments of job and family services to provide case management of nonemergency transportation services provided under the medicaid program. County departments shall provide the case management if required by the department in accordance with rules adopted under section 5164.02 of the Revised Code. The department shall determine, for the purposes of claiming fed...

...raining 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 department. Such training must be completed every twelve months. (2) In administering the integrated care delivery system, the department shall not require a personal care aide to do either of the following: (a) Complete more than thi...

...al retardation. (C) The department of medicaid shall not make medicaid payments to a nursing facility on behalf of any individual who is admitted to the facility in violation of division (B) of this section for the period beginning on the date of admission and ending on the date the requirements of division (B) of this section are met. (D) A determination under division (B) of this section is not required for any...

...(A) The department of medicaid shall conduct a desk review of each cost report it receives under section 5165.10 or 5165.522 of the Revised Code. Based on the desk review, the department shall make a preliminary determination of whether the reported costs are allowable costs. The department shall notify each nursing facility provider of whether any of the reported costs are preliminarily determined not to be al...

...The total per medicaid day payment rate determined under section 5165.15 of the Revised Code shall not be paid for nursing facility services provided to low case-mix residents. Instead, the total rate for such nursing facility services shall be one hundred fifteen dollars per medicaid day.

...If one or more medicaid-certified beds are relocated from one nursing facility to another nursing facility owned by a different person or government entity and the application for the certificate of need authorizing the relocation is filed with the director of health on or after July 1, 2005, amortization of the cost of acquiring operating rights for the relocated beds is not an allowable cost for the purpose o...

...No medicaid payment shall be made to a nursing facility provider for the day a medicaid recipient is discharged from the nursing facility.

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

...The department of medicaid shall make its best efforts each year to calculate nursing facilities' medicaid payment rates under this chapter in time to pay the rates by the fifteenth day of August of each state fiscal year. If the department is unable to calculate the rates so that they can be paid by that date, the department shall pay each provider the rate calculated for the provider's nursing facilities under this...

...ows that the provider received a lower medicaid payment rate under the original cost report than the provider was entitled to receive, the department of medicaid shall adjust the provider's rate for the nursing facility prospectively to reflect the corrected information. The department shall pay the adjusted rate beginning two months after the first day of the month after the provider files the amended cost re...

...The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the effective date of the change of operator if all of the following requirements are met: (A) The department receives a properly completed written notice required by section 5165.51 of the Revised Code on or before the date required by that section. (B) The department receives from the...

...(A) The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the date determined under division (B) of this section if all of the following are the case: (1) The department receives a properly completed written notice required by section 5165.51 of the Revised Code. (2) The department receives, from the entering operator and in accordance ...

...e nursing facility 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 5165.511 or 5165.512 of the Revised Code.

...The department of medicaid may enter into a provider agreement as provided in section 5165.07 of the Revised Code, rather than section 5165.511 or 5165.512 of the Revised Code, with an entering operator if the entering operator does not agree to a provider agreement that satisfies the requirements of division (A)(3) of section 5165.513 of the Revised Code. The department may not enter into the provider agreement unle...

...ed Code and the operator that holds the medicaid provider agreement for the facility issued under section 5165.07 of the Revised Code is the same person and is consistently identified for both purposes. (B) A nursing facility that has a difference in the identity of the operator that holds the license to operate the facility issued under section 3721.02 of the Revised Code and the operator holding the medicaid prov...

...e a cost report with the department of medicaid fails to file the cost report in accordance with that section, all payments under the medicaid program for the period the cost report is required to cover are deemed overpayments until the date the department receives the properly completed cost report. The department may impose on the exiting operator a penalty of one hundred dollars for each calendar day the pr...

...The department of medicaid may not provide an exiting operator final payment under the medicaid program until the department receives all properly completed cost reports the exiting operator is required to file under sections 5165.10 and 5165.522 of the Revised Code.

...The department of medicaid shall release the actual amount withheld under division (A) of section 5165.521 of the Revised Code, less any amount the exiting operator owes the department under the medicaid program, as follows: (A) Unless the department issues the initial debt summary report required by section 5165.525 of the Revised Code not later than sixty days after the date the exiting operator files the proper...

...The medicaid director may adopt rules under section 5165.02 of the Revised Code that are consistent with regulations, guidelines, and procedures issued by the United States secretary of health and human services under the "Social Security Act," sections 1819 and 1919, 42 U.S.C. 1395i-3 and 1396r, and necessary for administration and enforcement of sections 5165.60 to 5165.89 of the Revised Code. If the secretar...

...The department of medicaid may enter into contracts with other state agencies pursuant to section 5162.35 of the Revised Code that authorize the agencies to perform all or part of the duties assigned to the department of medicaid under sections 5165.60 to 5165.89 of the Revised Code. Each contract shall specify the duties the agency is authorized to perform and the sections of the Revised Code under which the a...

...At the time the department of medicaid or a contracting agency, under section 5165.71, 5165.72, or 5165.77 of the Revised Code, issues an order terminating a nursing facility's participation in the medicaid program, the department or agency may also impose a fine, in accordance with sections 5165.72 to 5165.74 and 5165.83 of the Revised Code, to be collected in the event the termination order does not take effe...

...The department of medicaid, the department of health, and any contracting agency shall deliver a written notice, statement, or order to a nursing facility under sections 5165.60 to 5165.66 and 5165.69 to 5165.89 of the Revised Code by certified mail, hand delivery, or other means reasonably calculated to provide prompt actual notice. If the notice, statement, or order is mailed, it shall be addressed to the administr...

...of the Revised Code, the department of medicaid shall establish a home first component for the Ohio home care waiver program. An individual is eligible for the Ohio home care waiver program's home first component if the individual has been determined to be eligible for the Ohio home care waiver program and at least one of the following applies: (1) If the individual is under twenty-one years of age, the indiv...

...ised Code and provided under any of the medicaid waiver components that the department administers under section 5166.21 of the Revised Code, the department shall consider both of the following: (1) The number of individuals with developmental disabilities placed on the county board's waiting list established for the services pursuant to section 5126.042 of the Revised Code; (2) Anything else the department consi...

...The medicaid director shall enter into a provider agreement with an individual to authorize the individual to provide home care attendant services to consumers if the individual does both of the following: (A) Agrees to comply with the requirements of sections 5166.30 to 5166.3010 and rules adopted under section 5166.02 of the Revised Code; (B) Provides the director evidence satisfactory to the director of a...

...n 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. (B) It shall not begin to pay for any services it covers until the amount of the noncore portion of the participa...

...(A) The medicaid director shall establish a system under which points are awarded in accordance with this section to healthy Ohio program debit swipe cards. One dollar of medicaid funds shall be deposited into a healthy Ohio program participant's buckeye account for each point awarded to the participant under this section. (B) The director shall provide a one-time award of twenty points to a healthy Ohio program par...

...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.

...If the medicaid program covers the pharmacist 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.

...Each medicaid managed care organization shall implement a coordinated services program for the organization's enrollees who are found to have obtained prescribed drugs under the medicaid program at a frequency or in an amount that is not medically necessary. The program shall be implemented in a manner that is consistent with section 1915(a)(2) of the "Social Security Act," 42 U.S.C. 1396n(a)(2), and 42 C.F.R. 431.54...

...Each medicaid managed care organization shall comply with federal and state efforts to identify fraud, waste, and abuse in the medicaid program.

...When a medicaid managed care organization seeks to recoup an overpayment made to a provider, it shall provide the provider all of the details of the recoupment, including all of the following information: (A) The name, address, and medicaid identification number of the enrollee to whom the services were provided; (B) The date or dates that the services were provided; (C) The reason for the recoupment; (D) Th...

...cy benefit manager shall provide to the medicaid director a written quarterly report containing the following information from the immediately preceding quarter: (1) The prices that the state pharmacy benefit manager negotiated for prescribed drugs under the care management system. The price must include any rebates the state pharmacy benefit manager received from the drug manufacturer; (2) The prices the state p...

...The medicaid director shall establish an appeals process by which pharmacies may appeal to the department of medicaid any disputes relating to the maximum allowable cost set by the state pharmacy benefit manager for a prescribed drug. All pharmacies participating in the care management system shall use the appeals process to resolve any disputes relating to the maximum allowable cost set by the state pharmacy benefit...

...etermining the amount the department of medicaid pays hospitals under section 5168.09 of the Revised Code and the amount of disproportionate share hospital payments paid by the medicare program pursuant to section 1915 of the "Social Security Act," 42 U.S.C. 1396n, a medicaid managed care organization shall keep detailed records for each hospital with which it contracts, including records regarding the cost to the ho...

...er than July 1, 2016, the department of medicaid shall implement strategies to improve the integrity of the care management system, including strategies to do both of the following: (A) Increase the department's oversight of medicaid managed care organizations; (B) Provide incentives for identifying fraud, waste, and abuse in the care management system.

...(A) The medicaid director shall adopt rules in accordance with Chapter 119. of the Revised Code for the purpose of administering sections 5168.01 to 5168.14 of the Revised Code, including rules that do all of the following: (1) Define as a "disproportionate share hospital" any hospital included under the "Social Security Act," section 1923(b), 42 U.S.C. 1396r-4(b), and any other hospital the director determines ap...

... United States centers for medicare and medicaid services determines that the assessment imposed under section 5168.06 of the Revised Code is a permissible health care-related tax pursuant to the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w). Whenever the department of medicaid is informed that the assessment is an impermissible health care-related tax, the department shall promptly refund to each hospit...

...ng each program year, the department of medicaid shall issue to each hospital the preliminary determination of the amount that the hospital is assessed under section 5168.06 of the Revised Code during the program year. The preliminary determination of a hospital's assessment shall be calculated for a cost-reporting period that is specified in rules adopted under section 5168.02 of the Revised Code. The department ...

...de and all recoveries the department of medicaid makes under section 5168.24 of the Revised Code shall be deposited into the fund. All investment earnings of the fund shall be credited to the fund. The department shall use money in the fund to pay for the costs of the medicaid program, including the program's administrative costs.

...each June, report to the department of medicaid the following: (1) For each nursing home, the number of beds in the nursing home licensed on the preceding first day of May under section 3721.02 or 3721.09 of the Revised Code or certified on that date under Title XVIII or Title XIX; (2) For each hospital, the number of beds in the hospital registered on the preceding first day of May pursuant to section 3701.0...

...the monthly franchise fee based on Ohio medicaid member months is due not later than the fifth business day of the month immediately following the month for which it is imposed. The component of the monthly franchise fee based on other Ohio member months is due not later than the last day of September of the calendar year in which the rate year ends, and the total amount due under that component for all of the months...

... insuring corporations receive enhanced medicaid payments or other state payments equal to seventy-five per cent or more of the total franchise fees imposed on their health insuring corporation plans, the department of medicaid shall refund the excess amount of the franchise fees to the health insuring corporations.

... United States centers for medicare and medicaid services determines that the franchise fee is an impermissible health care-related tax under section 1903(w) of the "Social Security Act," 42 U.S.C. 1396b(w), the department of medicaid shall do either of the following as appropriate: (A) Modify the imposition of the franchise fee, including (if necessary) the amount of the franchise fee, in a manner needed for the Un...

...The department of medicaid may offset the amount of a hospital's unpaid penalty imposed under section 5168.99 of the Revised Code from one or more payments due the hospital under the medicaid program. The total amount that may be offset from one or more payments shall not exceed the amount of the unpaid penalty.

...r as, the report that the department of medicaid submits to the general assembly and joint medicaid oversight committee pursuant to section 5162.13 of the Revised Code. A copy of the report also shall be submitted to the governor. (G) A facility, and any employee, contractor, or volunteer of a facility, that implements an infant safe sleep procedure in accordance with division (B) of this section is not liable for...

...e Revised Code, incorrect payments for medicaid services under the medicaid program, or any unpaid charge, penalty, or interest arising from any of the foregoing. If a taxpayer entitled to a refund under section 5736.08 of the Revised Code owes any debt to this state, the amount refundable may be applied in satisfaction of the debt. If the amount refundable is less than the amount of the debt, it may be appl...

...e Revised Code, incorrect payments for medicaid services under the medicaid program, or any unpaid charge, penalty, or interest arising from any of the foregoing. If a taxpayer entitled to a refund under section 5751.08 of the Revised Code owes any debt to this state, the amount refundable may be applied in satisfaction of the debt. If the amount refundable is less than the amount of the debt, it may be appl...

... satisfied the final judgment. (2) To medicaid provider agreements under the medicaid program. (3) When federal law dictates that a specified entity provide the goods, services, or construction for which a contract is being awarded, regardless of whether that entity would otherwise be prohibited from entering into the contract pursuant to this section. (G)(1) This section applies only to contracts for goods,...

... coverage of beneficiaries enrolled in medicaid.

...e Revised Code and to the governor and medicaid director.

...ew bills and resolutions regarding the medicaid program that are introduced in the general assembly. JMOC may submit a report of its review of a bill or resolution to the general assembly in accordance with section 101.68 of the Revised Code. The report may include JMOC's determination regarding the bill's or resolution's desirability as a matter of public policy. JMOC's decision on whether and when to review...

...One representative of the department of medicaid; (k) One representative of the department of insurance; (l) One representative of the department of children and youth; (m) One representative of the commission on minority health; (n) One representative of the Ohio hospital association; (o) One representative of Ohio health insurers; (p) One representative of bioOhio; (q) One representative of the...

...rector and other employees of the joint medicaid oversight committee shall serve the Ohio health oversight and advisory committee to enable the committee to successfully and efficiently perform its duties.

...e treasurer of state, the department of medicaid, the department of job and family services, the department of health, the department of mental health and addiction services, the department of developmental disabilities, opportunities for Ohioans with disabilities agency, and the department of aging may exchange information relating to eligible individuals for the purpose of administering or enforcing sections 113.50...

...and is subject to claims made under the medicaid estate recovery program instituted pursuant to section 5162.21 of the Revised Code, in accordance with subsection (f) of section 529A of the Internal Revenue Code and subject to any limitations imposed by the secretary. (H)(1) Notwithstanding any other provision of state law, all of the following shall be disregarded for the purposes of determining an individual's eli...

... of state may audit the accounts of any medicaid provider, as defined in section 5164.01 of the Revised Code. (D) If a public office has been audited by an agency of the United States government, the auditor of state may, if satisfied that the federal audit has been conducted according to principles and procedures not contrary to those of the auditor of state, use and adopt the federal audit and report in lieu of a...

...ncellor of higher education; (W) The medicaid director; (X) The director of education and workforce.

...mily services; (7) The department of medicaid; (8) The department of mental health and addiction services; (9) The opportunities for Ohioans with disabilities agency; (10) The department of children and youth. (B) In revising eligibility standards and eligibility determination procedures, a state agency shall not make any program's eligibility standards or eligibility determination procedures inconsist...

...r Ohioans with disabilities agency, the medicaid director, and the directors of youth services, job and family services, mental health and addiction services, health, developmental disabilities, aging, rehabilitation and correction, children and youth, and budget and management. The chairperson of the council shall be the governor or the governor's designee and shall establish procedures for the council's internal co...

...tive ethics committee; (2) The joint medicaid oversight committee; (3) The correctional institution inspection committee; (4) The legislative service commission; (5) The legislative information services; (6) The capitol square review and advisory board.

...ransportation improvement program fund, medicaid reserve fund, mental health facilities improvement fund, Ohio fairs fund, parks and recreation improvement fund, school district income tax fund, state agency facilities improvement fund, public safety - highway purposes fund, state lottery fund, undivided liquor permit fund, Vietnam conflict compensation bond retirement fund, volunteer fire fighters' dependents fund, ...

...ncluding social security, medicare, and medicaid. (B) Unless the power of attorney otherwise provides, language in a power of attorney granting general authority with respect to benefits from governmental programs or civil or military service authorizes the agent to do all of the following: (1) Execute vouchers in the name of the principal for allowances and reimbursements payable by the United States or a f...

...United States centers for medicare and medicaid, Ohio public employees deferred compensation program, Ohio police and fire pension fund, school employees retirement system, state teachers retirement system, state highway patrol retirement system, or Cincinnati retirement system. (E) A statement that contains information obtained from the system's records that is signed by the executive director or an officer ...

...of two different political parties. The medicaid director and directors of mental health and addiction services, developmental disabilities, health, and job and family services, or their designees, shall serve as ex officio members of the council. The purpose of the council is to advise the department of aging on the objectives of the "Older Americans Act of 1965," 42 U.S.C. 3001, and as directed by the governor. ...

...ssified by the centers for medicare and medicaid services as a long-term care hospital pursuant to 42 C.F.R. 412.23(e); (c) A county home or district home operated pursuant to Chapter 5155. of the Revised Code; (d) A residential facility licensed under section 5119.34 of the Revised Code that provides accommodations, supervision, and personal care services for three to sixteen unrelated adults or accommodations and...

...the senate, the director of health, the medicaid director, the director of job and family services, the director of mental health and addiction services, and the assistant secretary for aging of the United States department of health and human services. (b) Monitoring and analyzing the development and implementation of federal, state, and local laws, rules, and policies regarding long-term care services in this stat...

...ntative of a long-term care provider; a medicaid managed care organization, as defined in section 5167.01 of the Revised Code; a government entity; or a private social service agency. (B) The department of aging shall adopt rules in accordance with Chapter 119. of the Revised Code regarding the handling of complaints received under this section, including procedures for conducting investigations of complaints. The r...

...sified by the centers for medicare and medicaid services as a long-term care hospital pursuant to 42 C.F.R. 412.23(e); (3) County homes and district homes operated pursuant to Chapter 5155. of the Revised Code; (4) Residential facilities licensed under section 5119.34 of the Revised Code that provide accommodations, supervision, and personal care services for three to sixteen unrelated adults; (5) Facilities ...

... civil or criminal action regarding the medicaid program or a program the department of aging administers. (5) Pursuant to a lawful subpoena or valid court order, any necessary individual not identified in division (G)(4) of this section who is involved in a case dealing with any issue, matter, or action described in division (G)(4)(a), (b), or (c) of this section. (H) In a tort or other civil action for damages...

... (4) The contract or grant is not for medicaid-funded services, other than services provided under the PACE program administered by the department of aging under section 173.50 of the Revised Code. (B)(1) The director of aging shall adopt rules in accordance with Chapter 119. of the Revised Code governing both of the following: (a) Contracts and grant agreements between the department of aging or its designee a...

...and community-based services covered by medicaid components the department of aging administers, the department of aging or program administrator shall monitor the individual by doing either or both of the following at least once each year: (A) Determining whether the services being provided to the individual are appropriate; (B) Determining whether changes in the types of services being provided to the indiv...

...and community-based services covered by medicaid components the department of aging administers is dependent on the conduct of an assessment or other evaluation of the individual's needs and capabilities and the development of an individualized plan of care or services, the department shall develop and implement all procedures necessary to comply with the federal law. The procedures may include the use of long-term c...

...ts of department of aging-administered medicaid waiver components. The department or its designee shall ensure that no person providing the care management and authorization services performs an activity that may not be performed without a valid certificate or license issued by an agency of this state unless the person holds the valid certificate or license.

...erated by the centers for medicare and medicaid services of the United States department of health and human services from the quality measures developed as part of its nursing home quality initiative; (3) Results of the customer satisfaction surveys conducted under section 173.47 of the Revised Code; (4) Any other information the department specifies in rules adopted under section 173.49 of the Revised Code. ...

...alties, shall be reimbursed through the medicaid program. (B) There is hereby created in the state treasury the long-term care consumer guide fund. Money collected from the fees charged for the publication of the Ohio long-term care consumer guide under division (A) of this section and any late penalties shall be credited to the fund. The department shall use money in the fund for costs associated with publishing th...

... United States Centers for Medicare and Medicaid Services. (2) "Entity" has the same meaning as in 42 C.F.R. 460.10. (3) "PACE center," "PACE organization," "participant," and "state administering agency" have the same meanings as in 42 C.F.R. 460.6. (B)(1) Not later than one hundred twenty days after the effective date of this section, the Department of Aging shall issue a request for proposals from any enti...

...hall not be administered as part of the medicaid program. An individual who is eligible for the state-funded component may participate in the component for a period of time specified in rules adopted under this section. The director of aging shall adopt rules in accordance with section 111.15 of the Revised Code to implement the state-funded component. The rules shall specify the period that an individual eligible ...

...An individual enrolled in the medicaid-funded component of the assisted living program may choose a single occupancy room or multiple occupancy room in the residential care facility in which the individual resides. The choice of a multiple occupancy room is subject to approval pursuant to a process the director of aging shall establish in rules adopted under section 173.54 of the Revised Code.

...rance. (b) Coverage provided under the medicaid program. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of this section to the plan and its administrators. (B) A standardized identification card or an electronic tec...

... 5 U.S.C.A. 8905, or to the coverage of medicaid recipients, or to the coverage of beneficiaries under any federal health care program regulated by a federal regulatory body, or to the coverage of beneficiaries under any contract covering officers or employees of the state that has been entered into by the department of administrative services. (2) A health insuring corporation may offer coverage for diagnostic an...

...s amended. (b) Coverage provided under medicaid. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of this section to the plan and its administrators. (B) A standardized identification card or an electronic techno...

... 5 U.S.C.A. 8905, or to the coverage of medicaid recipients, or to the coverage of beneficiaries under any federal health care program regulated by a federal regulatory body, or to the coverage of beneficiaries under any contract covering officers or employees of the state that has been entered into by the department of administrative services. (D)(1) No health insuring corporation contract with a provider or ...

... is not eligible for coverage under the medicaid program or the medicare program. (2) That attainment of the limiting age for dependent children shall not operate to terminate the coverage of a dependent child if the child is and continues to be both of the following: (a) Incapable of self-sustaining employment by reason of physical disability or intellectual disability; (b) Primarily dependent upon the subs...

...or status as a recipient of medicare or medicaid, or any health status-related factor in relation to the individual. However, a health insuring corporation shall not be required to accept a recipient of medicare or medical assistance, if an agreement has not been reached on appropriate payment mechanisms between the health insuring corporation and the governmental agency administering these programs. Further, except ...

...5 U.S.C.A. 8905, or to the coverage of medicaid recipients or to the coverage of beneficiaries under any federal health care program regulated by a federal regulatory body, or to the coverage of beneficiaries under any contract covering officers or employees of the state that has been entered into by the department of administrative services.

...or risk contract entered into under the medicaid program. (F) The requirements of divisions (A) to (C) of this section apply only to health care services provided to an enrollee or subscriber prior to the effective date of a termination of a contract between the health insuring corporation and the provider or health care facility.

...coverage under a plan through medicare, medicaid, or the federal employees benefit program; any coverage issued under Chapter 55 of Title 10 of the United States Code and any coverage issued as a supplement to that coverage. (3) "Health plan issuer" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offers to c...

...l property taxes, claims made under the medicaid estate recovery program instituted pursuant to section 5162.21 of the Revised Code, and obligations for which the decedent was personally liable to the state or any of its subdivisions; (9) Debts for manual labor performed for the decedent within twelve months preceding the decedent's death, not exceeding three hundred dollars to any one person; (10) Other debts...

...nder this section is not a recipient of medicaid, the agency that refers the parent or caregiver for the tests may require the parent or caregiver to reimburse the agency for the cost of conducting the tests. (D) The community addiction services provider that conducts any alcohol or other drug tests ordered in accordance with divisions (B) and (C) of this section shall send the results of the tests, along with the ...

...s not a free clinic if the clinic bills medicaid, medicare, or other third-party payers for health care services rendered at the clinic, and receives twenty-five per cent or more of the clinic's annual revenue from the third-party payments. (3) "Health care professional" and "health care worker" have the same meanings as in section 2305.234 of the Revised Code.

...e; (3) Social security, medicare, and medicaid; (4) State-required, temporary, nonoccupational disability insurance; (5) Workers' compensation; (6) Wage continuation programs of any employer; (7) Proceeds of a contract of insurance payable to the victim for loss that the victim sustained because of the criminally injurious conduct; (8) A contract providing prepaid hospital and other health care services, ...

... bonds; (b) Prohibit the department of medicaid from recovering from the political subdivision, pursuant to section 5160.37 of the Revised Code, the cost of medical assistance provided under a medical assistance program. (C)(1) There shall not be any limitation on compensatory damages that represent the actual loss of the person who is awarded the damages. However, except in wrongful death actions brought pur...

... such as your social security number or medicaid number. 3. You must include with the caretaker authorization affidavit the following information: (a) The child's present address, the addresses of the places where the child has lived within the last five years, and the name and present address of each person with whom the child has lived during that period; (b) Whether you have participated as a party, a witnes...

...ce" means both of the following: (a) Medicaid; (b) Ohio works first under Chapter 5107. of the Revised Code. (2) "Rape" means a violation of section 2907.02 of the Revised Code or similar law of another state. (3) "Sexual battery" means a violation of section 2907.03 of the Revised Code if the sexual activity involved is sexual conduct, or similar law of another state.

... 5107. of the Revised Code or receiving medicaid an application for Title IV-D services; (I) That the staff person forward any completed acknowledgment of paternity, no later than ten days after it is completed, to the office of child support in the department of job and family services; (J) That the department of job and family services pay the hospital twenty dollars for every correctly signed and notarized o...

... 5101.80 of the Revised Code; (2) The medicaid program; (3) The unemployment compensation program authorized by Chapter 4141. of the Revised Code; (4) The supplemental nutrition assistance program authorized by section 5101.54 of the Revised Code; (5) Any other program authorized in 42 U.S.C. 1320b-7(b), as amended. (C) The administration of the employment security program under the director of job and fami...

...section 2923.36 of the Revised Code and medicaid fraud lien notices filed pursuant to section 2933.75 of the Revised Code; (29) Deeds for the purchase of burial lots or other interment rights under section 517.07 of the Revised Code. (B) All instruments or memoranda of instruments entitled to record shall be recorded in the order in which they are presented for recording. The recording of an option to purcha...

...hapter 5104. of the Revised Code; (b) Medicaid. (3) The Ohio works first program established by Chapter 5107. of the Revised Code; (4) The supplemental nutrition assistance program administered by the department of job and family services under section 5101.54 of the Revised Code; (5) The special supplemental nutrition program for women, infants, and children administered by the department of health under sec...

...ating in any of the following: (A) The medicaid program; (B) The Ohio works first program established under Chapter 5107. of the Revised Code; (C) The prevention, retention, and contingency program established under Chapter 5108. of the Revised Code.

...ograms' participants receive, including medicaid, publicly funded child care under Chapter 5104. of the Revised Code, supplemental nutrition assistance program benefits under section 5101.54 of the Revised Code, and energy assistance under Chapter 5117. of the Revised Code; (d) Other issues the committee considers appropriate. The committee shall make recommendations to the board of county commissioners and county ...

...f mental health and addiction services, medicaid director, executive director of the commission on minority health, executive director of the opportunities for Ohioans with disabilities agency, or director of education and workforce, on behalf of a program that receives public funds and provides services to children who are younger than compulsory school age, may request and receive, pursuant to section 3301.0723 of ...

...f mental health and addiction services, medicaid director, executive director of the commission on minority health, executive director of the opportunities for Ohioans with disabilities agency, or director of education and workforce and on behalf of a program that receives public funds and provides services to children younger than compulsory school age, the contractor shall assign a data verification code to a child...

... United States centers for medicare and medicaid services, Ohio public employees deferred compensation program, Ohio police and fire pension fund, school employees retirement system, public employees retirement system, state highway patrol retirement system, Cincinnati retirement system, a law enforcement agency, or a third party that the state teachers retirement system has contracted with for the purpose of admini...

... United States centers for medicare and medicaid services, Ohio public employees deferred compensation program, Ohio police and fire pension fund, state teachers retirement system, public employees retirement system, state highway patrol retirement system, Cincinnati retirement system, or a third party that the school employees retirement board has contracted with for the purpose of administering any part of this cha...

...tal disabilities, and the department of medicaid shall develop working agreements for pursuing additional funds for services for disabled children.

...bilities, aging, and public safety; the medicaid director; the administrator of workers' compensation; the director of education and workforce; and the executive director of the opportunities for Ohioans with disabilities agency. Any of the officials specified in this division may designate an individual to serve in the official's place as a member of the committee. Terms of office of the appointed members shall b...

...diction services and the department of medicaid shall adopt rules that establish requirements and procedures for prior notification and service coordination between public children services agencies and boards of alcohol, drug addiction, and mental health services when a public children services agency refers a child in its custody to a board for services funded by the board. The rules shall be adopted in acco...

...nd addiction services providers; (xv) Medicaid care coordinators or service providers; (xvi) Emergency or urgent care services providers; (xvii) Transportation providers; (xviii) Housing providers; (xix) The boy scouts of America, 4-H clubs, boys and girls clubs of America, and other similar organizations. (2) The board may form a multi-county council in accordance with division (C) of this section. (C)...

... the following information to the joint medicaid oversight committee created in section 103.41 of the Revised Code: (A) Notification that the local council has been established and information regarding the council's organization, plan, and activities; (B) Information regarding enrollment or outcome data collected under division (E) of section 355.03 of the Revised Code; (C) Recommendations regarding the best p...

... paid from federal funds or through the medicaid program. The department shall not charge the county for expenses exceeding the difference between the amount determined under division (A)(1) of this section and any amounts retained under divisions (A)(2) and (3) of this section. All amounts collected by the department under division (A)(1) of this section shall be deposited into the state treasury to the credit of...

... or the director's designee; (3) The medicaid director or the director's designee; (4) The executive director of the board of nursing or the director's designee; (5) The director of education and workforce or the director's designee; (6) A representative of an OhioMeansJobs center operator, as defined in section 6301.01 of the Revised Code, appointed by the director of job and family services; (7) An i...

...this state shall compile information on medicaid eligibility and application requirements and procedures and display copies of that information in a prominent location for the benefit of persons who seek or receive services from the clinic.

...ospital by the centers for medicare and medicaid services between January 1, 2001, and December 31, 2005, or is located in a rural area as identified below: (a) An area within an Ohio metropolitan area designated as a rural area by the United States department of health and human services, office of rural health policy, in accordance with 42 C.F.R. 412.103 regarding rural urban commuting area codes four through ten...

...the department of health, department of medicaid, department of administrative services, and commission on minority health to do all of the following: (1) Assess the prevalence of all types of diabetes in this state, including disparities in that prevalence among various demographic populations and local jurisdictions; (2) Establish and reevaluate goals for each of the agencies to reduce that prevalence; (3) Id...

...tor of health, in consultation with the medicaid director, shall adopt rules specifying the urban and rural communities that have the highest infant mortality rates in this state. The communities shall be identified by zip code or portions of zip codes that are contiguous. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.

... of such an agency, for purposes of the medicaid program, the medicare program, or any other public assistance program. (E) Any disclosure pursuant to this section shall be in writing and accompanied by a written statement that includes the following or substantially similar language: "This information has been disclosed to you from confidential records protected from disclosure by state law. You shall make no furt...

...aging, superintendent of insurance, and medicaid director a report of recommendations for improving the provision of palliative care in this state. The council shall submit the report to the general assembly in accordance with section 101.68 of the Revised Code. (F) The department of health shall provide to the council the administrative support necessary to execute its duties. At the request of the council, the ...

...ummit counties; (2) Providing care to medicaid recipients who are members of the group described in division (B) of section 5163.06 of the Revised Code. (E) A participating entity may employ or contract with licensed dental hygienists to educate pregnant women about the importance of prenatal and postnatal dental care. (F) The department may adopt rules as necessary to implement this section. The rules shall be...

...amily services, or their designees; the medicaid director, or the director's designee; and the director of education and workforce, or the director's designee. The commission shall elect a chairperson from among its members. Of the members appointed by the governor, five shall be appointed to initial terms of one year, and four shall be appointed to initial terms of two years. Thereafter, all members appointed ...

...d regional populations, pregnant women, medicaid recipients, and others who may be disproportionately affected by the use of tobacco. The department shall make copies of the plan available to the public. (B) The plan shall do both of the following: (1) Take into account the increasing use of electronic health records by health care providers and expanded health insurance coverage for tobacco cessation products an...

... the number of patients served who are medicaid recipients and individuals without health insurance.

...cally underserved population, including medicaid recipients, individuals without health insurance, individuals with disabilities, individuals with chronic health conditions, and individuals within racial or ethnic minority groups; (3) Components that include training in interdisciplinary cooperation between physicians, advanced practice registered nurses, and physician assistants in the patient centered medical home...

...rtified by the centers for medicare and medicaid services as an ambulatory surgical center, the director of health shall conduct an inspection of the facility each time the facility submits an application for license renewal. The director shall not renew the license unless all of the following conditions are met: (A) The inspector conducting the inspection completes each item on the following, as applicable: ...

...vered by a provider agreement under the medicaid program. (E) Nothing in this section requires a hospital to place a patient in any nursing home if the patient does not wish to be placed in the nursing home. Nothing in this section limits the ability of a hospital to file a certificate of need application for the addition of long-term care beds that meet the definition of "home" in section 3721.01 of the Revised Co...

... the activity; (D) The department of medicaid may refuse to enter into a provider agreement that includes a facility, beds, or services that result from the activity.

...ded, or nursing facility beds under the medicaid program, Title XIX of the "Social Security Act," 49 Stat. 286 (1965), 42 U.S.C. 1396, as amended; (3) An increase of hospital beds reported in an application submitted under section 3722.03 of the Revised Code as long-term care beds; (4) An increase of hospital beds reported in an application submitted under section 3722.03 of the Revised Code as special skilled nu...

...ded, or as a nursing facility under the medicaid program, Title XIX of the "Social Security Act," 42 U.S.C. 1396, as amended. (B) Subject to division (C) of this section, the director of health shall accept, for review under section 3702.52 of the Revised Code, certificate of need applications for an increase in beds in an existing long-term care facility if all of the following conditions are met: (1) The proposed...

... of the Revised Code, the department of medicaid. (2) The office of vital statistics also shall make available to the division of child support in the department of job and family services any other information recorded in the birth record that may enable the division to use the social security numbers provided under division (B)(1) of this section to obtain the location of the father of the child whose birth certi...

... entity providing respite care under a medicaid waiver component that the department of developmental disabilities administers pursuant to section 5166.21 of the Revised Code. (C) The department of health shall petition the court of common pleas of any county in which a person or public agency, without a license granted under section 3712.041 of the Revised Code, is holding itself out as providing a pediatric ...

...tion, directly or indirectly, from the medicaid program or the medicare program; (7) The facility meets all applicable state and federal health and safety standards, including standards for fire prevention, maintenance of safe and sanitary conditions, and proper preparation and storage of foods. (C) Hospice care program services may be provided at a terminal care facility for the homeless only by the personnel...

...be considered for employment; (b) The medicaid program does not reimburse the program the fee it pays under division (D)(1) of this section. (E) The report of a criminal records check conducted pursuant to a request 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 individual who...

...s for which the cost was covered by the medicaid program may be accepted and distributed under the drug repository program.

...hest quality care to residents who are medicaid recipients. The program may be funded with public funds appropriated by the general assembly for the purpose of the program or any funds appropriated for nursing home licensure.

...ements. (B) Unless the department of medicaid or contracting agency has taken action under section 5165.77 of the Revised Code to appoint a temporary manager or seek injunctive relief, if, in the judgment of the director of health, real and present danger exists at any home, the director may petition the court of common pleas of the county in which the home is located for such injunctive relief as is necessary to ...

...be considered for employment; (b) The medicaid program does not reimburse the home or program the fee it pays under division (D)(1) of this section. (E) The report of any criminal records check conducted pursuant to a request 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 indivi...

...by the federal centers for medicare and medicaid services, and addresses all of the required areas specified in 42 C.F.R. 483.152(b), except that if gaps in on-site training are identified, the individual also must complete supplemental training; (b) Has successfully completed the competency evaluation conducted by the director of health under section 3721.31 of the Revised Code. (G) The director shall adopt rule...

... United States centers for medicare and medicaid services granted a waiver of the prohibition on training and competency programs. (4) A long-term care facility, employee organization, person, or government entity seeking approval or reapproval of a training and competency evaluation program shall make an application to the director for approval or reapproval of the program and shall provide any documentation reque...

... United States centers for medicare and medicaid services, which shall reduce any civil monetary penalty imposed under this section by the same amount; (5) The home's history of compliance. (D) If the director determines the need for a civil monetary penalty under this section, the director may enter into settlement negotiations with the affected home. Settlements may include any of the following: (1) A less...

...by the federal centers for medicare and medicaid services in accordance with 42 U.S.C. 1395bb(a), or, in the case of a new hospital, eligible under rules adopted under section 3722.06 of the Revised Code; (3) Demonstrate the ability to comply with standards established in rules adopted under section 3722.06 of the Revised Code; (4) Specify the number of beds for the hospital, including skilled nursing beds, lon...

...by the federal centers for medicare and medicaid services or an accrediting organization approved under 42 U.S.C. 1395bb(a) provided that the plan was submitted to the centers or organization in response to the same deficiencies identified by the director. (D) The director may adopt any other rules as necessary to implement this chapter. (E) When adopting rules under this section, all of the following apply: ...

...by the federal centers for medicare and medicaid services.

...by the federal centers for medicare and medicaid services or an organization accepted by the department under section 3727.12 of the Revised Code, including by offering patients mechanical endovascular therapy, the department shall include that distinction in its recognition. (4) The department shall recognize as an acute stroke ready hospital a hospital that satisfies the requirements of division (B)(4) of sectio...

... United States centers for medicare and medicaid services and that certify stroke centers. (b) Include at a minimum both of the following: (i) Data that is consistent with nationally recognized treatment guidelines for patients with confirmed stroke; (ii) In the case of mechanical endovascular thrombectomy, data regarding the treatment's processes, complications, and outcomes, including data required by nati...

...by the federal centers for medicare and medicaid services or an organization that certifies hospitals in accordance with nationally recognized certification guidelines establishes a level of stroke certification that is in addition to the four levels described in sections 3727.11 to 3727.13 of the Revised Code, the department of health shall recognize a hospital certified at that additional level. For purposes of ...

...arried mother who is not a recipient of medicaid or a participant in Ohio works first an application for Title IV-D services; (H) Mail the voluntary acknowledgment of paternity, no later than ten days after it is completed, to the office of child support in the department of job and family services. Each hospital shall provide a notary public to notarize, or witnesses to witness, an acknowledgment of paternity ...

... United States centers for medicare and medicaid services implementing that section, including the rules and requirements under 45 C.F.R. 180. (G) "Hospital" has the same meaning as in section 3722.01 of the Revised Code. (H) "Hospital items or services" means all items or services, including individual items or services and service packages, that may be provided by a hospital to a patient in connection with an i...

... United States centers for medicare and medicaid services and recognized by the department pursuant to rules adopted under section 3740.10 of the Revised Code; (iii) Is certified by the department of aging under section 173.391 of the Revised Code to provide community-based long-term care services; (iv) Otherwise meets medicare conditions of participation, even though not certified for participation in the medi...

...ultation with the director of aging and medicaid director.

...y funded health program, including the medicaid program. Neither this section nor the rules adopted under it apply to a child if a parent of the child objects to the test on the grounds that the test conflicts with the parent's religious tenets and practices.

...m; (2) Disclosing to the department of medicaid on at least an annual basis the identity and lead screening test results of each child screened pursuant to section 3742.30 of the Revised Code. The director shall collect and disseminate information relating to child lead poisoning and controlling lead hazards. (B) The director of health shall operate the child lead poisoning prevention program in accordance with rul...

...) A representative of the department of medicaid; (2) A representative of the bureau of child care in the department of job and family services; (3) A representative of the department of environmental protection; (4) A representative of the department of education and workforce; (5) A representative of the department of development; (6) A representative of the department of children and youth; (7) A...

... underinsured, are not eligible for the medicaid program or any other government health program, and do not have access to another source of funds to cover the cost of lead tests and any indicated treatments; (2) Costs associated with having lead abatement performed or having the residential rental unit lead-safe maintenance practices specified in section 3742.42 of the Revised Code performed.

...es; (D) The centers for medicare and medicaid services; (E) The United States department of defense; (F) The centers for disease control and prevention; (G) The United States department of veterans affairs; (H) The drug enforcement administration; (I) The food and drug administration; (J) Any board recognized by the national institutes of health for the purpose of evaluating the medical value of ...

...The medicaid director shall adopt rules for purposes of specifying the criteria a person who is mentally or physically disabled and who is under twenty-one years of age must meet to be considered a minor for purposes of sections 3798.07 and 3798.12 of the Revised Code.

... United States centers for medicare and medicaid services. (3) When a provider or beneficiary submits a claim by using the standard claim form prescribed in the superintendent's rules, but the information provided in the claim is materially deficient, the third-party payer shall notify the provider or beneficiary not later than fifteen days after receipt of the claim. The notice shall state, with specificity, the i...

... payer that provides coverage under the medicaid program, shall not enter into a contractual arrangement under which time periods longer than those provided for in paragraph (c)(1) of 42 C.F.R. 447.46 are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider.

... health care benefits include medicare, medicaid, workers' compensation, the civilian health and medical program of the uniformed services and other elements of the tricare program offered by the United States department of defense, and similar state or federal programs. (D) Any provision of a contractual arrangement entered into between a third-party payer and a provider or beneficiary that is contrary to divisions...

...y payer for coverage provided under the medicaid program; (E) A third-party payer for coverage provided under the tricare program offered by the United States department of defense.

...Coverage under a plan through medicare, medicaid, or the federal employees benefit program; (g) Any coverage issued under Chapter 55 of Title 10 of the United States Code and any coverage issued as a supplement to that coverage. (2) "Health plan issuer" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offer...

...t apply to an auditing entity that is a medicaid managed care organization if application of those sections to the entity would be in violation of federal law.

...port to the general assembly, the joint medicaid oversight committee, and the governor, not later than the thirtieth day of January of each year.

... United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition cost of the drug, as defined in 42 U.S.C. 1395w-3a(c)(6)(B); (2) A dispensing fee reimbursement amount that is less than the reimbursement amount provided to a terminal distributor of dan...

... including the centers for medicare and medicaid services or the office of the national coordinator for health information technology. (E) A health plan issuer, including a pharmacy benefit manager, shall furnish the data required under division (B) of this section regardless of whether the request is made using the drug's unique billing code, such as a national drug code or health care common procedure coding syst...

...Individual eligibility requirements for medicaid; (5) The use of enrollment forms used in an exchange; (6) Any other topics as required by the superintendent. (C) Agents that complete the training program required under division (A) of this section shall receive continuing education course credit under sections 3905.481 to 3905.486 of the Revised Code. All such credit shall count toward satisfying the continuin...

...roviding information on eligibility for medicaid; (5) Engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice. (D) An individual shall not act in the capacity of an insurance navigator, or perform insurance navigator duties on behalf of an organization serving as an insurance navigator, unless the individual has applied for certification and the superintendent finds...

...affect the viator's eligibility for the medicaid program or other government benefits or entitlements, and that advice should be obtained from the appropriate government agencies; (e) That the viator has a right to rescind the viatical settlement contract for at least fifteen calendar days after the viator receives the viatical settlement proceeds, as provided in section 3916.08 of the Revised Code. If the ins...

... (d) The child is not eligible for the medicaid program or the medicare program. (2) That attainment of the limiting age for dependent children shall not operate to terminate the coverage of a dependent child if the child is and continues to be both of the following: (a) Incapable of self-sustaining employment by reason of an intellectual disability or physical disability; (b) Primarily dependent upon the p...

... (d) The child is not eligible for the medicaid program or the medicare program. (2) That attainment of the limiting age for dependent children shall not operate to terminate the coverage of a dependent child if the child is and continues to be both of the following: (a) Incapable of self-sustaining employment by reason of an intellectual disability or physical disability; (b) Primarily dependent upon the p...

...nd any policy that provides coverage to medicaid recipients. (B) Notwithstanding section 3901.71 of the Revised Code, and subject to division (E) of this section, every policy of sickness and accident insurance shall provide benefits for the diagnosis and treatment of biologically based mental illnesses on the same terms and conditions as, and shall provide benefits no less extensive than, those provided under the p...

...rance. (b) Coverage provided under the medicaid program. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of this section to the plan and its administrators. (B) A standardized identification card or an electronic tec...

...rance. (b) Coverage provided under the medicaid program. (B) A standardized identification card or an electronic technology issued or required to be used as provided in division (A)(1) of this section shall contain uniform prescription drug information in accordance with either division (B)(1) or (2) of this section. (1) The standardized identification card or the electronic technology shall be in a format and con...

...ailability of, or eligibility for, the medicaid program in this state or in any other state when determining an individual's eligibility for coverage or when making payments to or on behalf of an enrollee, subscriber, policyholder, or certificate holder.

...ost containment services and includes a medicaid managed care organization, as defined in section 5167.01 of the Revised Code. (K) "Maximum allowable cost" means a maximum drug product reimbursement for an individual drug or for a group of therapeutically and pharmaceutically equivalent multiple source drugs that are listed in the United States food and drug administration's approved drug products with therapeutic...

...ervices provided through a program for medicaid or medicare; (B) A contract for payments made to providers for rendering health care services to claimants pursuant to claims made under Chapter 4121., 4123., 4127., or 4131. of the Revised Code; (C) An exclusive contract between a health insuring corporation and a single group of providers in a specific geographic area to provide or arrange for the provision...

...d services programs established for the medicaid program under sections 5164.758 and 5167.13 of the Revised Code.

...ts made by the centers for medicare and medicaid services in the United States department of health and human services for reimbursement of conditional payments made pursuant to section 1395y(b)(2) of title 42, United States Code (commonly known as the "Medicare Secondary Payer Act"). (D) This section does not affect the right of a claimant to compensation accruing subsequent to the filing of any such application,...

...5101.54 of the Revised Code; (b) The medicaid program pursuant to Chapter 5163. of the Revised Code; (c) The Ohio works first program administered by the department of job and family services pursuant to section 5107.10 of the Revised Code; (d) The supplemental security income program pursuant to 20 C.F.R. 416.1100; (e) The United States department of veterans affairs pension benefit program pursuant to 3...

... 5101.54 of the Revised Code; (2) The medicaid program pursuant to Chapter 5163. of the Revised Code; (3) The Ohio works first program administered by the department of job and family services pursuant to section 5107.10 of the Revised Code; (4) The supplemental security income program pursuant to 20 C.F.R. 416.1100; (5) The United States department of veterans affairs pension benefit program pursuant to 38 U...

...that is certified under the medicare or medicaid program; (f) A hospice care program, as defined in section 3712.01 of the Revised Code; (g) A community mental health services provider, as defined in section 5122.01 of the Revised Code; (h) An ambulatory surgical facility, as defined in section 3702.30 of the Revised Code; (i) A freestanding birthing center, as defined in section 3701.503 of the Revised C...

...ndividual is seeking to be eligible for medicaid reimbursement as a state of Ohio certified doula. (D) The board shall adopt rules in accordance with Chapter 119. of the Revised Code establishing standards and procedures for issuing certificates to doulas under this section. The rules shall include all of the following: (1) Requirements for certification as a state of Ohio certified doula, including both of the f...

...that is certified under the medicare or medicaid program; (6) A hospice care program, as defined in section 3712.01 of the Revised Code; (7) A community mental health services provider, as defined in section 5122.01 of the Revised Code; (8) An ambulatory surgical facility, as defined in section 3702.30 of the Revised Code; (9) A freestanding birthing center, as defined in section 3701.503 of the Revised C...

.... and 4123. of the Revised Code and the medicaid program, and shall receive payment or reimbursement as provided under those chapters and that program. (C) Chapter 4796. of the Revised Code does not apply to a certificate to practice naprapathy or mechanotherapy issued under this section.

...n from participation in the medicare or medicaid programs by the department of health and human services or other responsible agency; (26) Impairment of ability to practice according to acceptable and prevailing standards of care because of substance use disorder or excessive use or abuse of drugs, alcohol, or other substances that may impair ability to practice. For the purposes of this division, any individua...

...ureau of workers' compensation, and the medicaid program. (E)(1) "Group practice" means a group of two or more holders of licenses or certificates under this chapter legally organized as a partnership, professional corporation or association, limited liability company, foundation, nonprofit corporation, faculty practice plan, or similar group practice entity, including an organization comprised of a nonprofit medi...

...ion requires a health care insurer, the medicaid program or any other government health care program, or any other entity that offers health care benefits to provide coverage for the costs incurred from the use of any investigational drug, product, or device. (H) Nothing in this section condones, authorizes, or approves of assisted suicide, as defined in section 3795.01 of the Revised Code, or any action that is con...

...ate entity that has its own medicare or medicaid provider number; (3) A manufacturer or wholesale distributor of home medical equipment that does not sell directly to the public; (4) A hospice care program, pediatric respite care program, or pediatric transition care program, as defined by section 3712.01 of the Revised Code, that does not sell or rent home medical equipment; (5) A home, as defined by section 3...

...ought under the medicare program or the medicaid program but all requests for payment for such services shall be made by the person who supervises the person performing the services.

...n from participation in the medicare or medicaid program established under Title XVIII and Title XIX, respectively, of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, as amended, for an act or acts that constitute a violation of sections 4755.40 to 4755.56 of the Revised Code; (21) Failure of a physical therapist to maintain supervision of a student, physical therapist assistant, unlicensed support ...

...ness and accident insurance policy, the medicaid program, or the health partnership program or qualified health plans established pursuant to sections 4121.44 to 4121.442 of the Revised Code, for any physical therapy service rendered without the prescription of, or the referral of the patient by, a person described in division (H)(1) of section 4755.48 of the Revised Code. (C) For purposes of this section, "business...

...n from participation in the medicare or medicaid programs by the department of health and human services or other responsible agency for any act or acts that also would constitute a violation of division (A)(11), (12), or (14) of this section; (18) Impairment of ability to practice according to acceptable and prevailing standards of care because of substance use disorder or excessive use or abuse of drugs, alcohol...

...n from participation in the medicare or medicaid programs by the department of health and human services or other responsible agency for any act or acts that also would constitute a violation of division (A)(10), (12), or (14) of this section; (18) Impairment of ability to practice according to acceptable and prevailing standards of care because of substance use disorder or excessive use or abuse of drugs, alcohol...

...s not apply to payments made under the medicaid program. (B) With respect to each period during which funds from a particular source are distributed for the purpose of providing family planning services, the department is subject to both of the following when distributing the funds to applicants seeking those funds: (1) Foremost priority shall be given to public entities that are operated by state or local g...

..., or the director's designee; (q) The medicaid director, or the director's designee. (B) Members who are appointed shall serve at the pleasure of the appointing authority. Vacancies shall be filled in the same manner as original appointments. (C) All members of the commission shall serve as voting members. The attorney general shall select from among the appointed members a chairperson. The commission shall mee...

...tance programs in this state, including medicaid, the supplemental nutrition assistance program, temporary assistance for needy families, or cash assistance, the number of: (a) Payments made in error, and the dollar amount of those payments; (b) Work requirement exemptions issued; (c) Confirmed cases of intentional program violation and fraud. (B) The department shall submit the report to the president of...

... Chapter 5107. of the Revised Code; the medicaid program; supplemental security income payments under Title XVI of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, as amended; or any other program under which eligibility or the level of benefits or assistance is based upon need measured by income.

...by the fee-for-service component of the medicaid program. (C) The department, based on factors it considers appropriate, shall allocate an amount to each county for reimbursement of drug costs incurred by the county pursuant to this section. (D) The director of mental health and addiction services may adopt rules as necessary to implement this section. The rules, if adopted, shall be adopted in accordance with ...

...ty Act," 42 U.S.C. 1381 et seq., if the medicaid program covers services provided in such institutions. The amount paid by the department shall not exceed the reduced supplemental security income benefit rate established by Title XVI of the "Social Security Act."

...port to the general assembly, the joint medicaid oversight committee, and the governor, not later than the thirtieth day of January of each year.

...ible, have the child participate in the medicaid program or a health insurance program; (3) Accept the normal risks of childrearing; (4) Abide by any court decisions regarding the allocation of parental rights and responsibilities with respect to the child. (B) Assign to the department any rights to support from any other person, excluding support assigned pursuant to section 5107.20 of the Revised Code and me...

... disabilities, education and workforce, medicaid, job and family services, and mental health and addiction services; the opportunities for Ohioans with disabilities agency; and each other state agency that provides employment services to individuals with developmental disabilities shall implement the policy of this state and ensure that it is followed whenever employment services are provided to individuals with deve...

... disabilities, education and workforce, medicaid, job and family services, and mental health and addiction services; and the opportunities for Ohioans with disabilities agency. The purpose of the task force shall be to improve the coordination of the state's efforts to address the needs of individuals with developmental disabilities who seek community employment as defined in section 5123.022 of the Revised Code. ...

... disabilities, education and workforce, medicaid, aging, job and family services, mental health and addiction services, and transportation; the opportunities for Ohioans with disabilities agency; and each other state agency that provides technology services to individuals with developmental disabilities shall implement the policy of this state and ensure that it is followed whenever technology services are provided t...

... disabilities, education and workforce, medicaid, aging, job and family services, mental health and addiction services, children and youth, and transportation; and the opportunities for Ohioans with disabilities agency. (B) The task force shall do all of the following: (1) Expand innovative technology solutions within the operation and delivery of services to individuals with developmental disabilities; (2) ...

...t fails to pay the nonfederal share of medicaid expenditures that the county board is required by sections 5126.059 and 5126.0510 of the Revised Code to pay. The department may bring the mandamus action in the court of common pleas of the county served by the county board or in the Franklin county court of common pleas.

... in consultation with the department of medicaid, office of budget and management, and county boards of developmental disabilities, shall adopt rules in accordance with Chapter 119. of the Revised Code to establish both of the following in the event a county property tax levy for services for individuals with developmental disabilities fails: (A) A method of paying for home and community-based services; (B) A metho...

... civil or criminal action regarding the medicaid program or a program the department administers. (2) An applicant or employee for whom the responsible entity has obtained reports under this section may submit a written request to the responsible entity to have copies of the reports sent to any state agency, entity of local government, or private entity. The applicant or employee shall specify in the request the ag...

... civil or criminal action regarding the medicaid program. (2) An applicant for whom the director has obtained reports under this section may submit a written request to the director to have copies of the reports sent to any person or state or local government entity. The applicant shall specify in the request the person or entities to which the copies are to be sent. On receiving the request, the director shall sen...

...responsible for the nonfederal share of medicaid expenditures for the individual's care in the state-operated ICF/IID. The department of developmental disabilities shall collect the amount of the nonfederal share from the county board by either withholding that amount from funds the department has otherwise allocated to the county board or submitting an invoice for payment of that amount to the county board. (B) Div...

...The department of medicaid shall not revalidate an ICF/IID provider agreement if the provider fails to maintain eligibility for the provider agreement as provided in section 5124.06 of the Revised Code.

...ermined not to be allowable costs, the medicaid payment rate determined under this chapter as a result of the determination regarding allowable costs, and the reasons for the determination and resulting rate. The department shall allow the provider to verify the calculation and submit additional information.

...t shall not take an action that affects medicaid payment rates for prior payment periods except in accordance with sections 5124.41 and 5124.42 of the Revised Code. (C) The director of developmental disabilities shall adopt rules under section 5124.03 of the Revised Code as necessary to implement this section.

...evelopmental disabilities shall adjust medicaid payment rates determined under this chapter to account for reasonable additional costs that must be incurred by ICFs/IID to comply with requirements of federal or state statutes, rules, or policies enacted or amended after January 1, 1992, or with orders issued by state or local fire authorities.

...hows that the provider received a lower medicaid payment rate under the original cost report than the provider was entitled to receive, the department of developmental disabilities shall adjust the provider's rate for the ICF/IID prospectively to reflect the corrected information. The department shall pay the adjusted rate beginning two months after the first day of the month after the provider files the amended cost...

... was not furnished increased the total medicaid payments to the provider during the fiscal year for which the costs were used to determine a rate. (B) If an exiting operator or owner fails to provide notice of a facility closure or voluntary termination as required by section 5124.50 of the Revised Code, or an exiting operator or owner and entering operator fail to provide notice of a change of operator as req...

...5124.109 of the Revised Code; (B) Any medicaid payment deemed an overpayment under section 5124.523 of the Revised Code; (C) Any penalty the department imposes under section 5124.42 of the Revised Code or section 5124.523 of the Revised Code.

...The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the effective date of the change of operator if all of the following requirements are met: (A) The department receives a properly completed written notice required by section 5124.51 of the Revised Code on or before the date required by that section. (B) The department receives both ...

...(A) The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the date determined under division (B) of this section if all of the following are the case: (1) The department receives a properly completed written notice required by section 5124.51 of the Revised Code. (2) The department receives, from the entering operator and in accordance ...

...vider agreement with the department of medicaid under section 5124.511 or 5124.512 of the Revised Code shall do all of the following: (A) Comply with all applicable federal statutes and regulations; (B) Comply with section 5124.07 of the Revised Code and all other applicable state statutes and rules; (C) Comply with all the terms and conditions of the exiting operator's provider agreement, including all of t...

...The department of medicaid may enter into a provider agreement as provided in section 5124.07 of the Revised Code, rather than section 5124.511 or 5124.512 of the Revised Code, with an entering operator if the entering operator does not agree to a provider agreement that satisfies the requirements of division (C) of section 5124.513 of the Revised Code. The department may not enter into the provider agreement u...

...h that section, all payments under the medicaid program for the period the cost report is required to cover are deemed overpayments until the date the department receives the properly completed cost report. The department may impose on the exiting operator a penalty of one hundred dollars for each calendar day the properly completed cost report is late.

...iting operator final payment under the medicaid program until the department receives all properly completed cost reports the exiting operator is required to file under sections 5124.10 and 5124.522 of the Revised Code.

...ntal disabilities may request that the medicaid director seek the approval of the United States secretary of health and human services to increase the number of slots available for home and community-based services by a number not exceeding the number of beds that were part of the licensed capacity of a residential facility that had its license revoked or surrendered under section 5123.19 of the Revised Code i...

... of developmental disabilities that has medicaid local administrative authority under division (A) of section 5126.055 of the Revised Code for home and community-based services and refuses to permit an individual to obtain home and community-based services from a qualified and willing provider shall provide the individual timely notice that the individual may appeal under section 5160.31 of the Revised Code. (B) Ex...

... United States centers for medicare and medicaid services. The department or designated entity shall notify the regional council or board of the date on which the audit is to begin. The department may permit a regional council or board to submit changes to the cost report before the audit begins. If the department or designated entity determines that a filed cost report is not auditable, it shall provide written no...

...ncluded in the plans are funded through medicaid; (4) Establish budgets for services based on the individual's assessed needs and preferred ways of meeting those needs; (5) Assist individuals in making selections from among the providers they have chosen; (6) Ensure that services are effectively coordinated and provided by appropriate providers; (7) Establish and implement an ongoing system of monitoring the ...

....47 of the Revised Code do not apply to medicaid-funded supported living. (B) As used in sections 5126.40 to 5126.47 of the Revised Code, "provider" means a person or government entity certified by the director of developmental disabilities to provide supported living for individuals with developmental disabilities. (C) On and after July 1, 1995, each county board of developmental disabilities shall plan and develo...

...The medicaid director shall adopt rules as necessary to implement this chapter.

...state treasury. Money the department of medicaid receives from private foundations in support of pilot projects that promote exemplary programs that enhance programs the department administers shall be credited to the fund. The department may expend the money on such projects, may use the money, to the extent allowable, to match federal financial participation in support of such projects, and shall comply with ...

...The department of medicaid may enter into contracts with private entities to maximize federal revenue without the expenditure of state money. In selecting private entities with which to contract, the department shall engage in a request for proposals process. The department, subject to the approval of the controlling board, may also directly enter into contracts with public entities providing revenue maximizati...

...The department of medicaid may appoint and commission any competent person to serve as a special agent, investigator, or representative to perform a designated duty for and on behalf of the department. Specific credentials shall be given by the department to each person so designated, and each credential shall state the following: (A) The person's name; (B) The agency with which the person is connected; (C) ...

...'s identity. (C)(1) The department of medicaid shall sign a memorandum of understanding with any department, agency, or division as needed to obtain the information specified in division (A) of this section. (2) The department may contract with one or more independent vendors to provide the information identified in division (A) of this section.

...If a violation of section 2913.401 of the Revised Code or a similar offense is suspected in the process of determining or redetermining a medical assistance recipient's eligibility, the case shall be referred for investigation to the county prosecutor of the county in which the medical assistance recipient resides, referred for an administrative disqualification hearing, or both.

...Revised Code prevents the department of medicaid or any entity with which the department has entered into an agreement under section 5160.30 of the Revised Code from doing either of the following: (A) Receiving or reviewing information related to individuals' eligibility for a medical assistance program beyond the information specified in division (A) of section 5160.29 of the Revised Code; (B) Contracting with ...

... (C) of this section, the department of medicaid may accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities for medical assistance programs. (B) The department may enter into agreements with one or more agencies of the federal government, the state, other states, and local governments of this or other states to accept applications, determine eligibil...

...the coverage; (3) Any other data the medicaid director specifies in rules authorized by section 5160.43 of the Revised Code. (B) "Medical support" means support specified as support for the purpose of medical care by order of a court or administrative agency. (C)(1) Subject to division (C)(2) of this section, and except as provided in division (C)(3) of this section, "third party" means all of the following:...

...de to cooperate with the department of medicaid and county department of job and family services, a medical assistance recipient and the recipient's attorney, if any, shall cooperate with each medical provider of the recipient. Cooperation with a medical provider shall consist of disclosing to the provider all information the recipient and attorney, if any, possess that would assist the provider in determining...

...) of this section to the department of medicaid. This assignment includes the rights of the medical assistance recipient and also the rights of any other member of the assistance group for whom the recipient can legally make an assignment. (B) Pursuant to this section, a medical assistance recipient assigns to the department any rights to medical support available to the recipient or other members of the reci...

...(A) The medicaid director may adopt rules under section 5160.02 of the Revised Code to implement sections 5160.35 to 5160.43 of the Revised Code, including rules that specify what constitutes cooperating with efforts to obtain support or payments, or medical assistance payments, and when cooperation may be waived. (B) The department shall adopt rules under section 5160.02 of the Revised Code to do all of the...

...uthorization; (b) If the department of medicaid has established a privacy notice that contains a description of how the individual or authorized representative may revoke the authorization, a reference to the privacy notice. (10) A statement that treatment, payment, enrollment, or eligibility for a medical assistance program cannot be conditioned on signing the authorization unless the authorization is necessa...

...(A) The department of medicaid shall do both of the following: (1) Enter into any necessary agreements with the United States department of health and human services and neighboring states to join and participate as an active member in the public assistance reporting information system; (2) Explore joining other multistate cooperatives, such as the national accuracy clearinghouse, to identify individuals enrolled i...

...and champva. (B) (1) The department of medicaid shall review information in the public assistance reporting information system to determine whether an individual who is a medical assistance recipient may be eligible for federal military-related health care benefits. If the department determines that the individual may be eligible for federal military-related health care benefits, it shall notify the individual of th...

...any agency other than the department of medicaid or a county department of job and family services, that other agency shall adopt rules consistent with sections 5160.45 to 5160.481 of the Revised Code to prevent the publication or disclosure of names, lists, or other information concerning those recipients.

...The department of medicaid shall administer the refugee medical assistance program authorized by the "Immigration and Nationality Act," section 412(e), 8 U.S.C. 1522(e).

...The medicaid director may adopt rules in accordance with Chapter 119. of the Revised Code as necessary for the efficient administration of the children's health insurance program, including rules that establish all of the following: (A) The conditions under which the program will pay for health benefits coverage; (B) The method of the payment; (C) The amount of payment, or the method by which the amount is t...

...The medicaid director may continue to operate the component of the children's health insurance program initially authorized by an executive order issued under section 107.17 of the Revised Code as long as federal financial participation is available for the program. If operated, the component shall pay for part or all of the cost of health benefits coverage for uninsured individuals under nineteen years of age ...

...hildren's health insurance program, the medicaid director may submit a state child health plan to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for part or all of the cost of health benefits coverage for uninsured individuals under nineteen years of age with family incomes above one hundred fifty per cent of the federal poverty line b...

...If the medicaid director submits a state child health plan to the United States secretary of health and human services under section 5161.10 of the Revised Code and the secretary approves the plan, the director shall implement CHIP part II in accordance with the plan. ; .

...hildren's health insurance program, the medicaid director may submit a request for a federal waiver to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for part or all of the cost of health benefits coverage for individuals under nineteen years of age with family incomes above two hundred per cent of the federal poverty line but not exce...

...If the medicaid director submits a waiver request to the United States secretary of health and human services under section 5161.15 of the Revised Code and the secretary grants the waiver, the director shall implement CHIP part III in accordance with the waiver.

...7cc; (B) Providing benefits under the medicaid program; (C) A combination of divisions (A) and (B) of this section.

...If the medicaid director determines that federal financial participation for CHIP part II, part III, or both parts is insufficient to pay for part or all of the costs of health benefits coverage for all the individuals the director anticipates are eligible for the part or parts, the director may refuse to accept new applications for the part or parts or may make the eligibility requirements more restrictive for...

...ction 2103(e), 42 U.S.C. 1397cc(e), the medicaid director may require an individual seeking to enroll, or who is enrolled, in CHIP part II to pay a premium, deductible, coinsurance payment, or other cost-sharing expense.

...ction 2103(e), 42 U.S.C. 1397cc(e), the medicaid director shall require an individual seeking to enroll, or who is enrolled, in CHIP part III to pay the following as a term of enrollment: (A) A premium of not less than forty dollars per month for a family with one individual seeking to enroll, or who is enrolled, in the part; (B) A premium of not less than eighty dollars per month for a family with two indivi...

...The medicaid director may contract with a government entity or person to perform the director's administrative duties regarding CHIP part I, part II, part III, two of the parts, or all three parts, other than the duty to submit a state child health plan to the United States secretary of health and human services under section 5161.10 of the Revised Code, the duty to submit a waiver request under section 5161.15...

...The medicaid director shall adopt rules as necessary to implement this chapter.

...t incorporates any provision of federal medicaid law, or that may be construed as requiring the state, a state agency, or any state official or employee to comply with that federal provision, shall be construed as creating a cause of action to enforce such state law beyond the causes of action available under federal law for enforcement of the provision of federal law.

...ederal financial participation for the medicaid program. This section does not affect the amount of funds a county is entitled to receive under sections 5101.16 and 5101.161 of the Revised Code.

...Any contract the department of medicaid enters into with the department of mental health and addiction services under section 5162.35 of the Revised Code is subject to the approval of the director of budget and management and shall require or specify all of the following: (A) That section 5162.371 of the Revised Code be complied with; (B) How providers will be paid for providing the services; (C) The respons...

...iliation fund. Money the department of medicaid receives from a refund or reconciliation shall be deposited into the refunds and reconciliation fund if the department does not know the appropriate fund for the money at the time the department receives the money or if the money is to go to another government entity. Money transferred from the department of job and family services under section 5101.074 of the Revised...

...The medicaid program's eligibility requirements for aged, blind, and disabled individuals may be more restrictive than the eligibility requirements for the supplemental security income program. Any such more restrictive eligibility requirements shall be consistent with the 209(b) option described in the "Social Security Act," section 1902(f), 42 U.S.C. 1396a(f).

...The medicaid program shall cover all of the following optional eligibility groups: (A) The group consisting of children placed with adoptive parents who are specified in section 1902(a)(10)(A)(ii)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(ii)(VIII); (B) Subject to section 5163.061 of the Revised Code, the group consisting of women during pregnancy and the maximum postpartum period permitted ...

...of the pregnancy who are covered by the medicaid program under division (B) of section 5163.06 of the Revised Code.

...in the income eligibility limit for the medicaid buy-in for workers with disabilities program, all of the following apply: (A) Twenty thousand dollars of the individual's earned income shall be disregarded. (B) No amount that the individual's employer pays to obtain health insurance for one or more members of the individual's family, including any amount of a premium established under section 5163.094 of the...

...um as a condition of qualifying for the medicaid buy-in for workers with disabilities program. The amount of the premium shall be determined as follows: (A) Subtract one hundred fifty per cent of the federal poverty line, as applicable for a family size equal to the size of the individual's family, from the amount of the income of the individual's family; (B) Subtract an amount specified in rules authorized b...

...An individual participating in the medicaid buy-in for workers with disabilities program may continue to participate in the program for up to six months even though the 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 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...

...ntifying 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 department of health.

...Medicaid payments for freestanding medical laboratory charges shall not exceed the customary and usual fee for laboratory profiles.

...t, 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 designation of an "intermediate care facility for individuals with intellectual disabilities" or "ICF/IID" is not deemed to refer to a nursing facility.

...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.

...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 the nursing home; (C) The operator and nursing facility comply with all applicable state and federal laws and rules.

...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.

...ty'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.

...The department of medicaid shall do all of the following: (A) Prescribe the form to be used for completing a cost report and a uniform chart of accounts for the purpose of reporting costs on the form; (B) Distribute a paper copy of the form, or computer software for electronic submission of the form, to each provider at least sixty days before the date the cost report is due; (C) Establish guidelines for com...

...s a cost report with the department of medicaid under section 5165.10 of the Revised Code, the provider may amend the cost report if the provider discovers a material error in the cost report or additional information to be included in the cost report. The department shall review the amended cost report for accuracy and notify the provider of its determination. (B) A provider may not amend a cost report if the...

...(A) The department of medicaid may conduct an audit, as defined in rules adopted under section 5165.02 of the Revised Code, of any cost report filed under section 5165.10 or 5165.522 of the Revised Code. The decision whether to conduct an audit and the scope of the audit, which may be a desk or field audit, may be determined based on prior performance of the provider, a risk analysis, or other evidence that gives the...

...ate fiscal year 2024, the department of medicaid shall conduct a rebasing at least once every five state fiscal years. When the department conducts the rebasing for a state fiscal year, it shall conduct the rebasing for only the direct care and tax cost centers.

... of the Revised Code, the department of medicaid shall determine the current average bank prime rate using statistical release H.15, "selected interest rates," a weekly publication of the federal reserve board, or any successor publication. If statistical release H.15, or its successor, ceases to contain the bank prime rate information or ceases to be published, the department shall request a written statement ...

...The department of medicaid shall transmit to the treasurer of state for deposit in the general revenue fund amounts collected from the following: (A) Refunds required by, and interest charged under, section 5165.41 of the Revised Code; (B) Amounts collected from penalties imposed under section 5165.42 of the Revised Code.

...ovider agreement with the department of medicaid under section 5165.511 or 5165.512 of the Revised Code shall do all of the following: (1) Comply with all applicable federal statutes and regulations; (2) Comply with section 5165.07 of the Revised Code and all other applicable state statutes and rules; (3) Subject to division (B) of this section, comply with all the terms and conditions of the exiting operator's pr...

...ode shall not affect the department of medicaid's determination of whether or when a change of operator occurs or the effective date of an entering operator's provider agreement under section 5165.511, section 5165.512, or, pursuant to section 5165.515, section 5165.07 of the Revised Code.

...ator shall file with the department of medicaid a cost report not later than ninety days after the last day the exiting operator's provider agreement is in effect or, in the case of a voluntary withdrawal of participation, the effective date of the voluntary withdrawal of participation. The cost report shall cover the period that begins with the day after the last day covered by the operator's most recent previ...

...The department of medicaid, at its sole discretion, may release the amount withheld under division (A) of section 5165.521 of the Revised Code if the exiting operator submits to the department written notice of a postponement of a change of operator, facility closure, or voluntary withdrawal of participation and the transactions leading to the change of operator, facility closure, or voluntary withdrawal of pa...

...The department of medicaid is hereby authorized to enforce sections 5165.60 to 5165.89 of the Revised Code. The department may enforce the sections directly or through contracting agencies. The department and agencies shall enforce the sections in accordance with the requirements of the "Social Security Act," sections 1819 and 1919, 42 U.S.C. 1395i-3 and 1396r, that apply to nursing facilities; with regulations...

...inistrative action by the department of medicaid or contracting agency under this chapter or is an action by any department or agency of the state to enforce this chapter or another chapter of the Revised Code; (B) An advertisement, unless the advertisement includes all of the following: (1) The date the survey was conducted; (2) A statement that the department of health conducts a survey of all nursing facilities...

...ent may consult with the department of medicaid, department of aging, and office of the state long-term care ombudsman program when determining whether a plan, or modification of an existing plan, to which division (A)(4) of this section applies conforms to the requirements for approval. The department of health has sole authority to make the determination regardless of whether it consults with the other depart...

...e should be imposed, the department of medicaid or a contracting agency shall do both of the following: (1) Impose the remedies that are most likely to achieve correction of deficiencies, encourage sustained compliance with certification requirements, and protect the health, safety, and rights of facility residents, but that are not directed at punishment of the facility; (2) Consider all of the following: (...

...(C) of this section, the department of medicaid and any contracting agency shall not release any of the following information without the permission of the individual or the individual's legal representative: (a) The identity of any resident of a nursing facility; (b) The identity of any individual who submits a complaint about a nursing facility; (c) The identity of any individual who provides the departme...

...Every home and community-based services medicaid waiver component shall reserve a portion of the participant capacity of the waiver for eligible individuals whose spouse or parent or legal guardian is an active duty military service member and, at the time of the service member's transfer to Ohio, the eligible individual was receiving home and community-based services in another state.

...h of the following: (a) Each dollar of medicaid funds deposited into the participant's buckeye account under division (B) of section 5166.402 of the Revised Code; (b) Each dollar contributed to the participant's buckeye account under divisions (C) and (D) of section 5166.402 of the Revised Code; (c) Each point awarded to the participant under section 5166.404 of the Revised Code. (2) Each time a healthy Ohio prog...

...red 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 to the participant.

...The medicaid director shall adopt rules under section 5166.02 of the Revised Code to do all of the following: (A) For the purpose 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 sectio...

...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.

...Each medicaid managed care organization shall provide a grievance process for the organization's enrollees in accordance with 42 C.F.R. 438, subpart F.

...Each medicaid managed care organization shall enter into a data security agreement with the state board of pharmacy governing the managed care organization's use of the board's drug database established and maintained under section 4729.75 of the Revised Code. This section does not apply if the board no longer maintains the drug database.

...Each medicaid managed care organization shall provide enhanced care management services for pregnant women and women capable of becoming pregnant in the communities specified in rules adopted under section 3701.142 of the Revised Code. The services shall be provided in a manner intended to decrease the incidence of prematurity, low birth weight, and infant mortality, as well as improve the overall health status of wo...

...Each medicaid managed care organization shall, if the organization requires practitioners to obtain prior approval before administering progesterone to the organization's enrollees who are pregnant, use a uniform prior approval form for progesterone that is not more than one page.

...ty in an amount to be determined by the medicaid director.

...The department of medicaid shall operate the hospital care assurance program established by sections 5168.01 to 5168.14 of the Revised Code on a program year basis. The department shall complete all program requirements on or before the thirtieth day of September each year.

...credited to the fund. The department of medicaid shall maintain records that show the amount of money in the hospital care assurance program fund at any time that has been paid by each hospital and the amount of any investment earnings on that amount. All moneys credited to the hospital care assurance program fund shall be used solely to make payments to hospitals under division (D) of this section and section 5168.0...

... released publicly by the department of medicaid or by any person under contract with the department who has access to such information.

...hospital submitted to the department of medicaid for purposes of the hospital care assurance program. If a hospital has not submitted that cost-reporting data to the department, the amount of a hospital's total facility costs shall be derived from other financial statements that the hospital shall provide to the department as directed by the department. The cost-reporting data or financial statements used to determin...

...essment program year, the department of medicaid shall issue to each hospital the preliminary determination of the amount that the hospital is assessed under section 5168.21 of the Revised Code for the assessment program year. Except as provided in division (B) of this section, the preliminary determination becomes the final determination for the assessment program year fifteen days after the preliminary determinatio...

...th a payment schedule the department of medicaid shall establish for each assessment program year. The department shall consult with the Ohio hospital association before establishing the payment schedule for any assessment program year. The department shall include the payment schedule in each preliminary determination notice the department issues to hospitals under division (A) of section 5168.22 of the Revised Code...

...The department of medicaid may audit a hospital to ensure that the hospital properly pays the amount it is assessed under section 5168.21 of the Revised Code. The department shall take action to recover from a hospital any amount the audit reveals that the hospital should have paid but did not pay.

...ection 1903(w), 42 U.S.C. 1396b(w), the medicaid director shall take all necessary actions to cease implementation of sections 5168.20 to 5168.27 of the Revised Code and shall promptly refund to each hospital the amount of money in the hospital assessment fund at the time the refund is to be made that the hospital paid under section 5168.23 of the Revised Code, plus any corresponding investment earnings on that amoun...

...ge changes, the new percentage. (J) "Medicaid days" and "nursing facility" have the same meanings as in section 5165.01 of the Revised Code. (K)(1) "Nursing home" means all of the following: (a) A nursing home licensed under section 3721.02 or 3721.09 of the Revised Code, including any part of a home for the aging licensed as a nursing home; (b) A facility or part of a facility, other than a hospital, tha...

... of the Revised Code, the department of medicaid shall, for each nursing home and hospital that qualifies for a reduction of its franchise permit fee rate under the waiver, reduce the franchise permit fee rate in accordance with the terms of the waiver. For purposes of the first fiscal year during which the waiver takes effect, the department shall determine the amount of the reduction not later than the effective da...

... of the Revised Code, the department of medicaid may do both of the following regarding the franchise permit fee assessed under section 5168.42 of the Revised Code: (1) Determine how much money the franchise permit fee would have raised in a fiscal year if not for the waiver; (2) For each nursing home and hospital subject to the franchise permit fee, other than a nursing home or hospital that has its franchise perm...

...ptember of each year, the department of medicaid shall determine the annual franchise permit fee for each nursing home and hospital in accordance with section 5168.42 of the Revised Code and any adjustments made in accordance with sections 5168.44 and 5168.45 of the Revised Code. (B) Not later than the first day of October of each year, the department shall notify, electronically or by United States postal service, ...

...ebruary of each year, the department of medicaid shall redetermine each nursing home's and hospital's franchise permit fee if one or more bed surrenders occur during the period beginning on the first day of May of the preceding calendar year and ending on the first day of January of the calendar year in which the redetermination is made. (B) In redetermining nursing homes' and hospitals' franchise permit fees under ...

...e change of operator. The department of medicaid is not required to notify the entering operator regarding the amount of that fiscal year's fee for which the entering operator is responsible.

...nstallment when due, the department of medicaid may assess a five per cent penalty on the amount due for each month or fraction thereof the installment is overdue.

...y on the grounds that the department of medicaid committed a material error in determining or redetermining the amount of the fee. A request for an appeal must be received by the department not later than fifteen days after the date the department notifies the nursing home or hospital of the fee and must include written materials setting forth the basis for the appeal. (B) If a nursing home or hospital submits a req...

...The department of medicaid may make any investigation it considers appropriate to obtain information necessary to fulfill its duties under sections 5168.40 to 5168.56 of the Revised Code. At the request of the department, the attorney general shall aid in any such investigations. The attorney general shall institute and prosecute all necessary actions for the enforcement of sections 5168.40 to 5168.56 of the R...

...ion 5124.01 of the Revised Code. (E) "Medicaid-certified capacity" has the same meaning as in section 5124.01 of the Revised Code. (F) "Provider agreement" has the same meaning as in section 5124.01 of the Revised Code.

...tal number of ICFs/IID receive enhanced medicaid payments or other state payments equal to seventy-five per cent or more of their total franchise permit fee assessments, do both of the following: (1) Recalculate the assessments under division (A) of this section using a per inpatient day rate equal to the indirect guarantee percentage of actual net patient revenue for all ICFs/IID for that fiscal year; (2) Refund...

...t of the following: (1) The ICF/IID's medicaid-certified capacity; (2) The number of days in the month.

...ible after the end of each quarter, the medicaid director shall certify to the director of budget and management the amount of money that is in the fund as of the last day of that quarter. On receipt of a certification, the director of budget and management shall transfer the amount so certified from the home and community-based services for persons with developmental disabilities fund to the department of developmen...

...The department of medicaid may request that a health insuring corporation provide the department documentation the department needs to verify the amount of the franchise fees imposed on the health insuring corporation plans administered by the corporation and to ensure the corporation's compliance with sections 5168.75 to 5168.86 of the Revised Code. On receipt of the request, the health insuring corporation shall pr...

...If the department of medicaid determines that the amount of a franchise fee that a health insuring corporation paid is less than the amount it should have paid, the department shall notify the health insuring corporation. Except as otherwise provided by the results of a reconsideration conducted under section 5168.80 of the Revised Code, the health insuring corporation shall pay the amount due.

...determination made by the department of medicaid under section 5168.79 of the Revised Code. A reconsideration may be requested solely on the grounds that the department made a material error in making the determination. A request for a reconsideration must be received by the department not later than fifteen days after the date the department notifies the health insuring corporation of the department's determination ...

...anchise fee when due, the department of medicaid may assess a ten per cent penalty on the amount due for each month or fraction thereof that the component of the franchise fee is overdue.

...The medicaid director may adopt rules in accordance with Chapter 119. as necessary to implement sections 5168.75 to 5168.86 of the Revised Code.

...ealth, maternal and infant support, and Medicaid-funded child health services.

... or the governor's designee; (4) The medicaid director or the director's designee; (5) The director of children and youth or the director's designee; (6) The director of health or the director's designee; (7) The director of developmental disabilities or the director's designee; (8) The executive director of the commission on minority health or the executive director's designee; (9) The attorney gen...

...t to the general assembly and the joint medicaid oversight committee. The copy to the general assembly shall be provided in accordance with section 101.68 of the Revised Code. (C) The director shall adopt rules specifying program performance indicators on which data must be reported by the administrators described in division (B) of this section as well as the format and time frames in which the data must be repor...

... United States centers for medicare and medicaid, public employees retirement system, Ohio public employees deferred compensation program, Ohio police and fire pension fund, school employees retirement system, state teachers retirement system, or Cincinnati retirement system. (F) A statement that contains information obtained from the system's records that is certified and signed by an officer of the retirement sys...

...The board of county commissioners of each county shall establish a county developmental disabilities general fund. Notwithstanding section 5705.10 of the Revised Code, proceeds from levies under section 5705.222 and division (L) of section 5705.19 of the Revised Code shall be deposited to the credit of the county developmental disabilities general fund. Accounts shall be established within the county developmental di...

...bilities to pay the nonfederal share of medicaid expenditures that the county board is required by sections 5126.059 and 5126.0510 of the Revised Code to pay.

... estate, including claims regarding the medicaid program or based on provisions of Chapters 5121. or 5123. of the Revised Code and claims sought to be satisfied by way of a civil action, subrogation, execution, garnishment, attachment, judicial sale, or other legal process, if all of the following apply: (1) At the time the trust is created, the trust principal does not exceed the maximum amount determined under div...

... 5107. of the Revised Code; (iii) The medicaid program; (iv) A program or law administered by the United States department of veterans' affairs or veterans' administration for any service-connected disability; (v) The supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.), administered by the department of job and family services under section 5...

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

...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...

...No nursing facility provider shall report fines paid under sections 5165.60 to 5165.89 or section 5165.99 of the Revised Code in a cost report filed under section 5165.10 or 5165.522 of the Revised Code.

...Cost reports shall be completed using the form prescribed under section 5165.104 of the Revised Code and in accordance with the guidelines established under that section.

...(A) There is hereby established the nursing facility payment commission. The commission shall consist of the following members: (1) Four members appointed by the speaker of the house of representatives, three from the majority party and one from the minority party; (2) Four members appointed by the president of the senate, three from the majority party and one from the minority party. (B) Appointments to the co...

...Except as provided in section 5165.17 of the Revised Code, the costs of goods, services, and facilities, furnished to a nursing facility provider by a related party are includable in the allowable costs of the provider at the reasonable cost to the related party.

...An operator shall comply with the "Social Security Act," section 1919(c)(2)(F), 42 U.S.C. 1396r(c)(2)(F) if the operator's nursing facility undergoes a voluntary withdrawal of participation.

...(A) The department of health shall conduct a survey, titled a standard survey, of every nursing facility in this state on a statewide average of not more than once every twelve months. Each nursing facility shall undergo a standard survey at least once every fifteen months as a condition of meeting certification requirements. The department may extend a standard survey; such a survey is titled an extended surve...

...(A) A department of health survey team shall conclude each survey of a nursing facility not later than one business day after the survey team ceases to need to be on site at the facility for the survey. Not later than the day that the survey team concludes the survey, the survey team shall conduct an exit interview with the administrator or other person in charge of the facility and any other facility staff mem...

...The department of health may appoint employees of the department to conduct on-site monitoring of a nursing facility whenever a finding is cited, including any finding cited pursuant to division (E) of section 5165.66 of the Revised Code, or an emergency is found to exist. Appointment of monitors under this section is not subject to appeal under section 5165.87 or any other section of the Revised Code. No emplo...

...(A) Whoever violates section 5165.102 or division (E) of section 5165.08 of the Revised Code shall be fined not less than five hundred dollars nor more than one thousand dollars for the first offense and not less than one thousand dollars nor more than five thousand dollars for each subsequent offense. Fines paid under this section shall be deposited in the state treasury to the credit of the general revenue fund. (...

...A home care attendant shall complete not less than twelve hours of in-service continuing education regarding home care attendant services each year and provide the appropriate director evidence satisfactory to the appropriate director that the attendant satisfied this requirement. The evidence shall be submitted to the appropriate director not later than the annual anniversary of the issuance of the home care a...

...A home care attendant shall do all of the following: (A) Maintain a clinical record for each consumer to whom the attendant provides home care attendant services in a manner that protects the consumer's privacy; (B) Participate in a face-to-face visit every ninety days with all of the following to monitor the health and welfare of each of the consumers to whom the attendant provides home care attendant services...

...(A) A home care attendant may assist a consumer with nursing tasks or self-administration of medication only after the attendant does both of the following: (1) Subject to division (B) of this section, completes consumer-specific training in how to provide the assistance that the authorizing health care professional authorizes the attendant to provide to the consumer; (2) At the request of the consumer, consu...

...A home care attendant shall comply with both of the following when assisting a consumer with nursing tasks or self-administration of medication: (A) The written consent of the consumer or consumer's authorized representative provided to the appropriate director under section 5166.306 of the Revised Code; (B) The authorizing health care professional's written authorization provided to the appropriate director ...

...To consent to a home care attendant assisting a consumer with nursing tasks or self-administration of medication, the consumer or consumer's authorized representative shall provide the appropriate director a written statement signed by the consumer or authorized representative under which the consumer or authorized representative consents to both of the following: (A) Having the attendant assist the consumer ...

...To authorize a home care attendant to assist a consumer with nursing tasks or self-administration of medication, a health care professional shall provide the appropriate director a written statement signed by the health care professional that includes all of the following: (A) The consumer's name and address; (B) A description of the nursing tasks or self-administration of medication with which the attendant ...

...When authorizing a home care attendant to assist a consumer with nursing tasks or self-administration of medication, a health care professional may not authorize a home care attendant to do any of the following: (A) Perform a task that is outside of the health care professional's scope of practice; (B) Assist the consumer with the self-administration of a medication, including a schedule II, schedule III, sch...

...A home care attendant who provides home care attendant services to a consumer in accordance with the authorizing health care professional's authorization does not engage in the practice of nursing as a registered nurse or in the practice of nursing as a licensed practical nurse in violation of section 4723.03 of the Revised Code. A consumer or the consumer's authorized representative shall report to the appro...

...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...

...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...