Ohio Revised Code Search
Section |
---|
Section 5165.76 | Fine collected if termination order does not take effect.
...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... |
Section 5165.86 | Delivery of notices.
...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... |
Section 5166.121 | Home first component for the Ohio home care waiver program.
...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... |
Section 5166.22 | Allocating enrollment numbers to county board of developmental disabilities.
...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... |
Section 5166.301 | Home care attendant services providers.
...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... |
Section 5166.401 | Enrolllment for healthy Ohio program participants.
...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... |
Section 5166.404 | Points award system.
...(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... |
Section 5167.04 | Inclusion of alcohol, drug addiction, and mental health services in care management system.
...The department of medicaid shall include alcohol, drug addiction, and mental health services covered by medicaid in the care management system. |
Section 5167.05 | Inclusion of prescribed drugs in care management system.
...The department of medicaid may include prescribed drugs covered by the medicaid program in the care management system. |
Section 5167.051 | Coverage of services provided by pharmacist.
...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. |
Section 5167.10 | Authority to contract with managed care orgainizations.
...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. |
Section 5167.13 | Implementation of coordinated services program for enrollees who abuse prescribed drugs.
...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... |
Section 5167.18 | Identification of fraud, waste, and abuse.
...Each medicaid managed care organization shall comply with federal and state efforts to identify fraud, waste, and abuse in the medicaid program. |
Section 5167.22 | Recoupment of overpayment.
...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... |
Section 5167.243 | Quarterly reports.
...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... |
Section 5167.245 | Appeals process.
...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... |
Section 5167.26 | Records for determining costs.
...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... |
Section 5167.32 | Improving integrity of care management system.
...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. |
Section 5168.02 | Adoption of rules.
...(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... |
Section 5168.03
... 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... |
Section 5168.08 | Preliminary determination of assessment.
...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 ... |
Section 5168.25 | Hospital assessment fund.
...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. |
Section 5168.46 | Annual reports.
...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... |
Section 5168.77 | Component due dates.
...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... |
Section 5168.83 | Refunds.
... 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. |
Section 5101.02 | Authority of director of job and family services.
...The director of job and family services is the executive head of the department of job and family services. All duties conferred on the various work units of the department by law or by order of the director shall be performed under such rules as the director prescribes, and shall be under the director's control. |
Section 5101.03 | Assistant directors - powers and duties.
...The assistant directors of the department of job and family services shall exercise the powers and perform the duties which the director of job and family services may order. The director is authorized to designate which assistant director shall act as director in the absence or disability of the director or in case of a vacancy in the position of director. |
Section 5101.04 | Contract with commercial consumer reporting agency.
...(A) Notwithstanding any provision of law or regulation to the contrary, in order to improve the timeliness of public assistance benefit deliveries, to maximize operational efficiencies, increase cost savings, and minimize fraud, the department of job and family services may contract with a third-party commercial consumer reporting agency, in accordance with the "Fair Credit Reporting Act," 15 U.S.C. 1681 et seq., for... |
Section 5101.041 | Data matching agreements.
...(A) The director of job and family services shall enter into the following data matching agreements: (1) An agreement with the department of rehabilitation and correction, under which the director of rehabilitation and correction is required to provide the director of job and family services with a searchable list, updated weekly, identifying all persons committed to the several institutions governed by the departm... |
Section 5101.042
...program; (4) Benefits provided by the medicaid program; (5) Publicly funded child care as defined in section 5104.01 of the Revised Code. (B) The department of job and family services shall update the systems used by the department and by county departments of job and family services to determine eligibility for public assistance benefits programs. The updates shall include a mechanism by which application info... |
Section 5101.05 | Appointing employees.
...The director of job and family services may appoint such employees as are necessary for the efficient operation of the department of job and family services. The director may prescribe the title and duties of the employees. |
Section 5101.051 | Filling positions with peculiar and exceptional qualifications.
...If the director of job and family services determines that a position with the department of job and family services can best be filled in accordance with division (A)(2) of section 124.30 of the Revised Code or without regard to a residency requirement established by a rule adopted by the director of administrative services, the director of job and family services shall provide the director of administrative service... |
Section 5101.06 | Establishing work units.
...The director of job and family services may establish work units within the department of job and family services as necessary for the efficient operation of the department. The director shall appoint the chief of each work unit. |
Section 5101.061 | Office of human services innovation.
...(A) There is hereby established in the department of job and family services the office of human services innovation. The office shall develop recommendations, as described in division (B) of this section, regarding the coordination and reform of state programs to assist the residents of this state in preparing for life and the dignity of work and to promote individual responsibility and work opportunity. The dire... |
Section 5101.07 | Support services federal operating fund.
...There is hereby created in the state treasury the support services federal operating fund. The fund shall consist of federal funds the department of job and family services receives and that the director of job and family services determines are appropriate for deposit into the fund. Money in the fund shall be used to pay the federal share of both of the following: (A) The department's costs for computer projects; ... |
Section 5101.071 | Support services state operating fund.
...There is hereby created in the state treasury the support services state operating fund. The fund shall consist of payments made to the fund from other appropriation items by intrastate transfer voucher. Money in the fund shall be used to pay for both of the following: (A) The department of job and family services' costs for computer projects; (B) The operating costs of the parts of the department that provide gene... |
Section 5101.072 | Human services projects fund.
...There is hereby created in the state treasury the human services projects fund. The fund may consist of intrastate agency transfers, nonfederal grants, and other similar revenue sources. The department of job and family services shall use the fund to support program and administrative expenses related to the implementation of human services initiatives within the department. |
Section 5101.073 | ODJFS general services administration and operating fund.
...There is hereby created in the state treasury the ODJFS audit settlements and contingency fund. The fund shall be used to pay for required audits, settlements, contingencies, and other related expenses. As necessary for the purposes of the fund, the director of job and family services may request the director of budget and management to transfer money from any of the funds used by the department of job and family ser... |
Section 5101.074 | Disposition of refunds.
...refund or reconciliation related to the medicaid program, the department shall transfer the money to the department of medicaid for deposit into the refunds and reconciliation fund created under section 5162.65 of the Revised Code. |
Section 5101.08 | Fidelity bonds.
...The director of job and family services may require any of the employees of the department of job and family services who may be charged with custody or control of any public money or property or who is required to give bond, to give a bond, properly conditioned, in a sum to be fixed by the director which when approved by the director, shall be filed in the office of the secretary of state. The cost of such bonds, wh... |
Section 5101.09 | Adopting rules.
...(A) When the director of job and family services or the director of children and youth is authorized by the Revised Code to adopt a rule, the director shall adopt the rule in accordance with the following: (1) Chapter 119. of the Revised Code if any of the following apply: (a) The rule concerns the administration or enforcement of Chapter 4141. of the Revised Code; (b) The rule concerns a program administere... |
Section 5101.10 | Expending funds.
...The director of job and family services may expend funds appropriated or available to the department of job and family services from public or private entities, including other governmental agencies; public or private institutions, organizations, agencies, and corporations; and individuals. For purposes of this section, the director may enter into contracts or agreements with public and private entities and make gran... |
Section 5101.101 | Order of priority for distribution of funds for family planning services.
...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... |
Section 5101.11 | Seeking federal financial participation for costs incurred by entity implementing program administered by department.
...(A) As used in this section: (1) "Entity" includes an agency, board, commission, or department of the state or a political subdivision of the state; a private, nonprofit entity; a school district; a private school; or a public or private institution of higher education. (2) "Federal financial participation" means the federal government's share of expenditures made by an entity in implementing a program administ... |
Section 5101.111 | Foundation grant fund.
...The foundation grant fund is hereby created in the state treasury. Money the department of job and family services or the department of children and youth receives from private foundations in support of pilot projects that promote exemplary programs for enhancing the health, safety, and well-being of children and families shall be credited to the fund. The applicable department may expend the money on such projects, ... |
Section 5101.12 | Maximizing receipt of federal revenue.
...The department of job and family services or department of children and youth may enter into contracts to maximize federal revenue without the expenditure of state money. In selecting private entities with which to contract, the applicable department shall engage in a request for proposals process. The applicable department, subject to the approval of the controlling board, may also directly enter into contracts with... |
Section 5101.13 | [Amended and renumbered as R.C. 5180.40 by H.B. 96, 136th General Assembly, effective 9/30/2025] Uniform statewide automated child welfare information system.
...(A) The department of children and youth shall establish and maintain a uniform statewide automated child welfare information system in accordance with the requirements of 42 U.S.C.A. 674(a)(3)(C) and related federal regulations and guidelines. The information system shall contain records regarding any of the following: (1) Investigations of children and families, and children's care in out-of-home care, in accord... |
Section 5101.131 | [Amended and renumbered as R.C. 5180.401 by H.B. 96, 136th General Assembly, effective 9/30/2025] Child welfare system information confidential.
...Except as provided in section 5101.132 of the Revised Code, information contained in or obtained from the information system established and maintained under section 5101.13 of the Revised Code is confidential and is not subject to disclosure pursuant to section 149.43 or 1347.08 of the Revised Code. |
Section 5101.132 | [Amended and renumbered as R.C. 5180.402 by H.B. 96, 136th General Assembly, effective 9/30/2025] Access to child welfare system information.
...(A) Information contained in the information system established and maintained under section 5101.13 of the Revised Code may be accessed or entered only as follows: (1) The department of job and family services, the department of children and youth, a public children services agency, a title IV-E agency, a prosecuting attorney, a private child placing agency, and a private noncustodial agency may access or enter t... |
Section 5101.133 | [Amended and renumbered as R.C. 5180.403 by H.B. 96, 136th General Assembly, effective 9/30/2025] Use and disclosure of system information restricted.
...No person shall access or use information contained in the information system established and maintained under section 5101.13 of the Revised Code other than in accordance with section 5101.132 of the Revised Code or rules authorized by that section. No person shall disclose information obtained from the information system established and maintained under section 5101.13 of the Revised Code in a manner not specified... |