Ohio Revised Code Search

...The medicaid program may cover a health care service that a pharmacist provides to a medicaid recipient in accordance with Chapter 4729. of the Revised Code, including any of the following services: (A) Managing drug therapy under a consult agreement pursuant to section 4729.39 of the Revised Code; (B) Administering immunizations in accordance with section 4729.41 of the Revised Code; (C) Administering drugs ...

...nd palliative interventions rendered to individuals in an individual or group setting by a mental health professional in accordance with a plan of treatment appropriately established, monitored, and reviewed; (2) Partial-hospitalization mental health services rendered by persons directly supervised by a mental health professional; (3) Unscheduled, emergency mental health services of a kind ordinarily provided t...

...The medicaid program may cover one or more state plan home and community-based services that the department of medicaid selects for coverage. A medicaid recipient of any age may receive a state plan home and community-based service if the recipient has countable income not exceeding two hundred twenty-five per cent of the federal poverty line, has a medical need for the service, and meets all other eligibility requir...

...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.

...nate a medicaid service included in the individual service plan developed for a medicaid recipient with a developmental disability who is eligible for medicaid case management services. If either department approves, reduces, denies, or terminates a service, that department shall timely notify the medicaid recipient that the recipient may appeal pursuant to section 5160.31 of the Revised Code.

...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...

...Not later than December 31, 2018, the department of medicaid shall develop and implement revisions to the system by which persons and government entities become and remain medicaid providers so that there is a single system of records for the system and the persons and government entities do not have to submit duplicate data to the state to become or remain medicaid providers for any component or aspect of a componen...

...The department of medicaid shall establish a credentialing program that includes a credentialing committee to review the competence, professional conduct, and quality of care provided by medicaid providers. Any activities performed by the credentialing committee shall be considered activities of a peer review committee of a health care entity and shall be subject to sections 2305.25 to 2305.253 of the Revised Code....

...No person or government entity may participate in the medicaid program as a medicaid provider without a valid provider agreement with the department of medicaid.

...(A) As used in this section, "group practice" has the same meaning as in section 4731.65 of the Revised Code. (B) The department of medicaid shall establish a process by which a physician assistant may enter into a provider agreement. (C)(1) Subject to division (C)(2) of this section, a claim for medicaid payment for a medicaid service provided by a physician assistant to a medicaid recipient may be submitted ...

...(A) For the purpose of raising funds necessary to pay the expenses of implementing the provider screening requirements of subpart E of 42 C.F.R. Part 455 and except as provided in division (B) of this section, the department of medicaid shall collect an application fee from a medicaid provider before doing any of the following: (1) Entering into a provider agreement with a medicaid provider that seeks initial enroll...

...(A) Each medicaid provider agreement shall expire not later than five years from its effective date. If a provider agreement entered into before the effective date of this amendment does not have a time limit, the department of medicaid shall convert the agreement to a provider agreement with a time limit. (B) The medicaid director shall adopt rules under section 5164.02 of the Revised Code as necessary to i...

... a provider agreement; (2) Exclude an individual, provider of services or goods, or other entity from participation in the medicaid program. (B) No individual, provider, or entity excluded from participation in the medicaid program under this section shall do any of the following: (1) Own, or provide services to, any other medicaid provider or risk contractor; (2) Arrange for, render, or order services for m...

...ucted pursuant to 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 person who is the subject of the criminal records check or the person's representative; (2) The medicaid director and the staff of the department who are involved in the administration of the medicaid program; (3) The depa...

...ction 109.5721 of the Revised Code is a public record for the purposes of section 149.43 of the Revised Code. Such a report or notice shall not be made available to any person other than the following: (1) The person who is the subject of the criminal records check or the person's representative; (2) The medicaid director and the staff of the department who are involved in the administration of the medicaid pro...

...equest 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 applicant or employee who is the subject of the criminal records check or the representative of the applicant or employee; (2) The chief administrator of the waiver agency that requires the applicant or employee to request th...

... impression as to law, value, state of mind, or other objective or subjective fact. No proof of specific intent to defraud is required to show, for purposes of this section, that a medicaid provider has engaged in deception. (C) Any medicaid provider who violates division (B) of this section shall be liable, in addition to any other penalties provided by law, for all of the following civil penalties: (1) Paymen...

...ment of medicaid. (2) "Disqualifying indictment" means an indictment of a medicaid provider or its officer, authorized agent, associate, manager, employee, or, if the provider is a noninstitutional provider, its owner, if either of the following applies: (a) The indictment charges the person with committing an act to which both of the following apply: (i) The act would be a felony or misdemeanor under the la...

...that division; (2) The department rescinds its notice to terminate the provider agreement. (3) The department issues an order regarding the termination of the provider agreement pursuant to an adjudication conducted in accordance with Chapter 119. of the Revised Code. (E) This section does not limit the department's authority to suspend or terminate a provider agreement or medicaid payments to a medicaid provid...

...rmination, suspension, or exclusion is binding on the provider's participation in the medicaid program in this state; (d) The provider's pleading guilty to or being convicted of a criminal activity materially related to either the medicare or medicaid program; (e) The provider or its owner, officer, authorized agent, associate, manager, or employee having been convicted of one of the offenses that caused the pr...

...In any action taken by the department of medicaid under section 5164.38 or 5164.57 of the Revised Code or any other state statute governing the medicaid program that requires the department to give notice of an opportunity for a hearing in accordance with Chapter 119. of the Revised Code, if the department gives notice of the opportunity for a hearing but the medicaid provider or other entity subject to the not...

...i) Community inclusion services. (2) "Independent provider" means an individual who personally provides aide services or nursing services under the medicaid program and is not employed by, under contract with, or affiliated with another entity that provides the services. (3) "Nursing services" means all of the following: (a) Nursing services covered by the medicaid program as part of the home health services be...

...(A) The department of medicaid may contract with any person or persons as a fiscal agent for the examination, processing, and determination of medicaid claims. The contracting party may provide any of the following services, as required by the contract: (1) Design and operate medicaid management information systems, including the provision of data processing services; (2) Determine the amounts of payments to ...

...(A) As used in this section, "electronic claims submission process" means any of the following: (1) Electronic interchange of data; (2) Direct entry of data through an internet-based mechanism implemented by the department of medicaid; (3) Any other process for the electronic submission of claims that is specified in rules adopted under section 5162.02 of the Revised Code. (B) Not later than January 1, 2013,...