Ohio Revised Code Search

...ayments and expenditures, including the individual and total dollar amounts for claims that were determined to be the result of fraud, waste, or abuse; (2) Federal and state recovered funds, including the dollar amounts per claim and the total dollar amounts concerning fraud, waste, and abuse in the medicaid program; (3) Aggregate data concerning improper payments and ineligible medicaid recipients who received m...

...owing information: (A) The number of individuals who participated in the medicaid buy-in for workers with disabilities program; (B) The cost of the program; (C) The average amount of earned income of participants' families; (D) The average amount of time participants have participated in the program; (E) The types of other health insurance participants have been able to obtain.

... shall make the report available to the public.

...(A) As used in this section, "stillbirth" has the same meaning as in section 5180.12 of the Revised Code. (B) The department of medicaid shall create an infant mortality scorecard. The scorecard shall report all of the following: (1) The performance of the fee-for-service component of medicaid and each medicaid managed care organization on population health measures, including the infant mortality rate, preterm...

...ed in division (A) of this section, the individuals affected by the barriers, and whether the barriers result from policies implemented by the department, medicaid managed care organizations, providers, or others; (b) Recommendations for the expedient removal of the access barriers; (c) An analysis of the performance of the fee-for-service component of medicaid and the performance of each medicaid managed care or...

...Annually, the department of medicaid shall conduct a cost savings study of the medicaid program and prepare a report based on that study recommending measures to reduce costs under that program. The department shall submit its report to the governor.

...(A) The department of medicaid shall periodically evaluate the success that members of the expansion eligibility group have with the following: (1) Obtaining employer-sponsored health insurance coverage; (2) Improving health conditions that would otherwise prevent or inhibit stable employment; (3) Improving the conditions of their employment, including duration and hours of employment. (B) For the purpose...

...(A) The medicaid director shall immediately provide notice in accordance with this section if the United States centers for medicare and medicaid services does any of the following related to a quarterly medicaid statement of expenditures for medical assistance programs form that is submitted by the department of medicaid: (1) Determines that the form has a variance of expenditures of eight per cent or greater; (...

...(A) As used in this section; "Agent" and "contractor" include any agent, contractor, subcontractor, or other person who, on behalf of an entity, furnishes or authorizes the furnishing of medicaid services, performs billing or coding functions, or is involved in monitoring of health care that an entity provides. "Employee" includes any officer or employee (including management employees) of an entity. "Entity...

...A government entity that administers one or more components of the medicaid program and has reasonable cause to believe that an instance of fraud, waste, or abuse has occurred in the medicaid program shall inform the department of medicaid. The department shall collect the information in the medicaid data warehouse system established under section 5162.11 of the Revised Code.

...anufacturer's representative, employee, independent contractor, or agent, shall pay any copayment on behalf of a medicaid recipient. (E) If it is the routine business practice of a provider to refuse service to any individual who owes an outstanding debt to the provider, the provider may consider an unpaid copayment imposed by the cost-sharing requirements as an outstanding debt and may refuse service to a medicaid...

... property and other assets in which an individual had any legal title or interest at the time of death (to the extent of the interest), including assets conveyed to a survivor, heir, or assign of the individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement. (2) "Institution" means a nursing facility, ICF/IID, or a medical institution. (3) "Permanently ...

... be imposed against the property of an individual before the individual's death on account of medicaid services correctly paid or to be paid on the individual's behalf. (B) Except as provided in division (C) of this section, the department of medicaid may impose a lien against the real property of a medicaid recipient who is a permanently institutionalized individual and against the real property of the recip...

...The department of medicaid shall certify amounts due under the medicaid estate recovery program instituted under section 5162.21 of the Revised Code to the attorney general pursuant to section 131.02 of the Revised Code. The attorney general may enter into a contract with any person or government entity to collect the amounts due on behalf of the attorney general. The attorney general, in entering into a cont...

...(A) As used in this section: (1) "Commissioner" means a person appointed by a probate court under division (E) of section 2113.03 of the Revised Code to act as a commissioner. (2) "Home" has the same meaning as in section 3721.10 of the Revised Code. (3) "Personal needs allowance account" means an account or petty cash fund that holds the money of a resident of a residential facility or home and that the fac...

...(A) The medicaid director shall adopt rules under section 5162.02 of the Revised Code permitting county departments of job and family services to take action to recover benefits incorrectly paid on behalf of medicaid recipients. The rules shall provide for recovery by the following methods: (1) Soliciting voluntary payments from recipients or from persons holding property in which a recipient has a legal or e...

...(A) As used in this section, "third party" has the same meaning as in section 5160.35 of the Revised Code. (B) In addition to the authority granted under section 5160.38 of the Revised Code, the department of medicaid may, to the extent necessary to reimburse its costs, garnish the wages, salary, or other employment income of, and withhold amounts from state tax refunds to, any person to whom both of the follo...

...(A) As used in this section: (1) "State directed payment program" means a payment program authorized by the United States centers for medicare and medicaid services under 42 C.F.R. 438.6(c). (2) "Preprint" means a form created by the United States centers for medicare and medicaid services to request approval of a state directed payment program, as required under 42 C.F.R. 438.6(c). (B)(1) Except as provided in...

...The department of medicaid shall prepare and submit quarterly reports to the legislative service commission and the chairpersons of the standing committees in the house of representatives and the senate with jurisdiction over medicaid regarding any new state directed payment programs established under section 5162.25 of the Revised Code.

...(A) The medicaid director shall create a medicaid administrative claiming program under which federal financial participation is received for the administrative costs incurred by the department of health and the Arthur G. James cancer hospital and Richard J. Solove research institute of the Ohio state university in analyzing and evaluating both of the following pursuant to sections 3701.261 and 3701.262 of the ...

...Local funds, whether from public or private sources, expended by a county department of job and family services for administration of the healthy start component shall be considered to have been expended by the state for the purpose of determining the extent to which the state has complied with any federal requirement that the state provide funds to match federal financial participation for the medicaid program...

...The department of medicaid may enter into contracts with political subdivisions to use funds of the political subdivision to pay the nonfederal share of expenditures under the medicaid program. The determination and provision of federal financial participation to a subdivision entering into a contract under this section shall be determined by the department, subject to section 5162.40 of the Revised Code.

...The department of medicaid may enter into contracts with one or more other state agencies or political subdivisions to have the state agency or political subdivision administer one or more components of the medicaid program, or one or more aspects of a component, under the department's supervision. A state agency or political subdivision that enters into such a contract shall comply with the terms of the contra...

...The medicaid director shall create, in accordance with sections 5162.36 to 5 162.366 of the Revised Code, the medicaid school component of the medicaid program.

...A qualified medicaid school provider participating in the medicaid school component of the medicaid program may submit a claim to the department of medicaid for federal financial participation for providing, in schools, services covered by the medicaid school component to medicaid recipients who are eligible for the services. No qualified medicaid school provider may submit such a claim before the provider incurs the...