Ohio Revised Code Search

...of care as determined by an assessment conducted under section 173.546 of the Revised Code; (B) While receiving assisted living services under the medicaid-funded component, reside in a residential care facility that is authorized by a valid medicaid provider agreement to participate in the component, including both of the following: (1) A residential care facility that is owned or operated by a metropolitan h...

...iting that the individual has a medical condition that, unless the individual is enrolled in home and community-based services such as the assisted living program, will require the individual to be admitted to a nursing facility within thirty days of the physician's or nurse's determination. (c) The individual has been hospitalized and a physician, certified nurse-midwife if authorized as described in section 4723...

...The department of aging shall create and administer the state-funded component of the assisted living program. The state-funded component shall 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 ...

... of care as determined by an assessment conducted under section 173.546 of the Revised Code. (B) The individual must have an application for the medicaid-funded component of the assisted living program pending and the department or the department's designee must have determined that the individual meets the nonfinancial eligibility requirements of the medicaid-funded component and not have reason to doubt that the...

... an entity designated by the department concerning participation in or services provided under the component if the action will result in any of the following: (1) Denial of enrollment or continued enrollment in the component; (2) Denial of or reduction in the amount of services requested by or offered to the individual under the component; (3) Assessment of any patient liability payment pursuant to rules adopted ...

...artment of medicaid or an agency under contract pursuant to division (C) of this section shall conduct the assessment. The assessment may be performed concurrently with a long-term care consultation provided under section 173.42 of the Revised Code. (B) An applicant or applicant's representative has the right to appeal an assessment's findings. Section 5160.31 of the Revised Code applies to appeals regarding ...

...A residential care facility providing services covered by the assisted living program to an individual enrolled in the program shall have staff on-site twenty-four hours each day who are able to do all of the following: (A) Meet the scheduled and unpredicted needs of the individuals enrolled in the assisted living program in a manner that promotes the individuals' dignity and independence; (B) Provide supervi...

... 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.

...(A) As used in this section: (1) "Department of aging-administered medicaid waiver component" means both of the following: (a) The medicaid-funded component of the PASSPORT program; (b) The medicaid-funded component of the assisted living program. (2) "PACE program" means the component of the medicaid program the department of aging administers pursuant to section 173.50 of the Revised Code. (B) If the departmen...

...rules may allow an appeal hearing to be conducted by telephone and permit the department to record hearings conducted by telephone. Chapter 119. of the Revised Code applies to a hearing under section 173.523 or 173.545 of the Revised Code only to the extent provided in rules the department adopts under this section. (B) An appeal shall be commenced by submission of a written request for a hearing to the direc...

... quality improvement organization under contract with the United States secretary of health and human services to carry out in this state the functions described in the "Social Security Act," section 1154, 42 U.S.C. 1320c-3; (c) The Ohio person-centered care coalition; (d) Any other academic, research, or health care entity identified by the department. (2) The department shall offer to nursing homes and oth...

...nter into a contract with any person under which the person operates a program for the provision of outpatient prescription drug discounts to any or all of the following: (1) Individuals who are sixty years of age or older; (2) Individuals whose family incomes do not exceed three hundred per cent of the federal poverty guidelines, as revised annually by the United States department of health and human servic...

... or the attorney general's designee, in consultation with county departments of job and family services, adult protective services agencies, the Ohio bankers league, the community bankers association of Ohio, the securities industry and financial markets association, and the Ohio credit union league, shall work together to do all of the following: (1) Develop best practices and standards for preventing elder fraud ...

... (C) of section 173.24 of the Revised Code is subject to a fine not to exceed one thousand dollars for each violation. (B) Whoever violates division (C) of section 173.23 of the Revised Code is guilty of registering a false complaint, a misdemeanor of the first degree. (C) Whoever violates division (G)(1) or (2) of section 173.19 of the Revised Code is subject to a fine not to exceed five hundred dollars for each v...

... record," "person," "primary care provider," "provider," "specialty health care services," "subscriber," and "supplemental health care services" have the same meanings as in section 1751.01 of the Revised Code.

...r seeking to enter into a participation contract with the health insuring corporation of the status of the provider's application within one hundred twenty days after the health insuring corporation's receipt of the provider's completed application. That time period may be extended by a health insuring corporation if, due to extenuating circumstances, the health insuring corporation needs additional time to consider ...

...o a participation contract with a provider under section 1751.13 of the Revised Code, a health insuring corporation shall disclose basic information regarding its programs and procedures to the provider. The information shall include all of the following: (a) How a participating provider is reimbursed for the participating provider's services, including the range and structure of any financial risk sharing a...

...velop a performance improvement plan in conjunction with the participating provider. If after being afforded the opportunity to comply with the performance improvement plan, the participating provider fails to do so, the health insuring corporation may terminate the participation of the provider. (B)(1) A participating provider whose participation has been terminated under division (A) of this section may appeal t...

...ealth insuring corporation to employ or contract with, or prohibits a health insuring corporation from employing or contracting with, any category of provider for the provision of basic or supplemental health care services, which health care services are within the recognized scope of practice of that category of provider.

...olicy, contract, or agreement that provides basic health care services but does not allow direct access to obstetricians or gynecologists shall permit a female enrollee to obtain covered obstetric and gynecological services from a participating obstetrician or gynecologist without obtaining a referral from the enrollee's primary care provider. No individual or group health insuring corporation policy, contract, or a...

...f a primary care provider determines in consultation with a specialist that an enrollee needs continuing care from a specialist. The referral shall be made pursuant to a treatment plan approved by the health insuring corporation in consultation with the primary care provider, a specialist, and the enrollee. The treatment plan may limit the number of visits to the specialist, limit the period of time that the visits a...

... authorization and all of the terms and conditions of the provider's contract with the health insuring corporation.

...n shall do both of the following: (1) Develop such a formulary in consultation with and with the approval of a pharmacy and therapeutics committee, a majority of the members of which are physicians or advanced practice registered nurses affiliated with the health insuring corporation who may prescribe prescription drugs and pharmacists affiliated with the health insuring corporation; or in consultation with and wit...

...icacious for a particular indication or condition when compared to alternative therapies, or whether it remains experimental or investigational. The health insuring corporation's internal technology assessment process shall meet all of the following criteria: (A) Decisions are made by medical professionals, including physicians. (B) The process includes a review of relevant medical evidence, including the following...

...erity, including severe pain, that a prudent layperson with an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in any of the following: (a) Placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy; (b) Serious impairment to bodily functions; (c) Serious dysfunctio...