Ohio Revised Code Search

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

...e medicaid director shall adopt rules under sections 5160.02, 5162.02, 5163.02, 5164.02, 5165.02, 5166.02, and 5167.02 of the Revised Code as necessary to authorize the directors of other state agencies to adopt rules regarding medicaid components, or aspects of medicaid components, the other state agencies administer pursuant to contracts entered into under section 5162.35 of the Revised Code.

..., pursuant to contracts entered into under section 5162.35 of the Revised Code. No state agency or political subdivision may establish, by rule or otherwise, a policy governing medicaid that is inconsistent with a medicaid policy established, in rule or otherwise, by the director.

... 1902(a)(5), 42 U.S.C. 1396a(a)(5), the department of medicaid shall act as the single state agency to supervise the administration of the medicaid program. As the single state agency, the department shall comply with 42 C.F.R. 431.10(e) and all other federal requirements applicable to the single state agency.

...tment's duties concerning individuals' eligibility for medicaid services, under section 5163.02 of the Revised Code; (3) If the rules concern the department's duties concerning financial and operational matters between the department and county departments of job and family services, under section 5162.02 of the Revised Code.

...ing as in section 9.23 of the Revised Code. No provision of Title LI of the Revised Code or any other law of this state that 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 ac...

... by the United States secretary; (B) Federal medicaid waivers granted by the United States secretary, including amendments to waivers approved by the United States secretary; (C) Other types of federal approval, including demonstration grants, that establish requirements for components of the medicaid program; (D) Except as otherwise authorized by a federal medicaid waiver granted by the United States secreta...

...cease if the federal approval is ultimately denied.

...The medicaid director shall seek federal approval for all components, and aspects of components, of the medicaid program for which federal approval is needed, except that the director is permitted rather than required to seek federal approval for components, and aspects of components, that state statutes permit rather than require be implemented. Federal approval shall be sought in the following forms as approp...

...e with section 5166.03 of the Revised Code, the department of medicaid shall not seek or implement an amendment to the medicaid state plan or a medicaid waiver under section 1115 or 1915 of the "Social Security Act," 42 U.S.C. 1315 and 42 U.S.C. 1396n, that would expand medicaid coverage to any additional individuals or class of individuals or increase any net costs to the state, without first providing notice to the...

... medicaid program. The reviews may include physical inspections of records and sites where medicaid services are provided and interviews of medicaid providers and medicaid recipients. If the director determines pursuant to a review that a person or government entity has violated a rule governing the medicaid program, the director may establish a corrective action plan for the violator and impose fiscal, adminis...

...rvices to contract through competitive selection pursuant to section 125.07 of the Revised Code with a vendor to perform an assessment of the data collection and data warehouse functions of the medicaid data warehouse system, including the ability to link the data sets of all agencies serving medicaid recipients. The assessment of the data system shall include functions related to fraud and abuse detection, progra...

...data from reports of audits conducted under section 5165.109 of the Revised Code, or extracts or analyses of any of the foregoing data made by persons who intend to use the items prepared pursuant to the requests for commercial or academic purposes. (B) At a minimum, a contract entered into under this section shall do both of the following: (1) Authorize the contracting person to engage in the activities describe...

...rt shall include all of the following, delineated by race and ethnic group: (1) The estimated number of pregnant women, infants, and children eligible for the program; (2) The actual number of eligible persons enrolled in the program; (3) The actual number of enrolled pregnant women categorized by estimated gestational age at time of enrollment; (4) The average number of days between the following events: (...

...data concerning improper payments and ineligible medicaid recipients who received medicaid services as a percentage of the claims investigated or reviewed; (4) The number of payments made in error, the dollar amount of those payments within the medicaid program, and the number of confirmed cases of intentional program violation and fraud. (B) Each report shall be made available on the department's web site. The ...

...ce with section 101.68 of the Revised Code. The report shall include all of the following 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 ...

...sed Code regarding the integrated care delivery system. The director shall provide a copy of the report to the general assembly in accordance with section 101.68 of the Revised Code. The director also shall make the report available to the public.

...birthweight rate, and stillbirth rate, delineated in accordance with division (C) of this section; (2) The performance of the fee-for-service component of medicaid and each medicaid managed care organization on service utilization and outcome measures using claims data and data from vital records; (3) The number and percentage of women who are at least fifteen but less than forty-four years of age who are medic...

...(A) The department of medicaid shall conduct periodic reviews to determine the barriers that medicaid recipients face in gaining full access to interventions intended to reduce tobacco use, prevent prematurity, and promote optimal birth spacing. The first review shall occur not later than sixty days after April 6, 2017. Thereafter, reviews shall be conducted every six months. The department shall prepare a report tha...

...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.

...e 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 of aiding the department's evaluations under this section, m...

...edicaid 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; (2) Asks a...

... contractors, and agents in a paper or electronic form and make the written policies readily available to the entity's employees, contractors, and agents. (4) If the entity has an employee handbook, include in the employee handbook a specific discussion of the laws specified in division (B)(1) of this section, the rights of employees to be protected as whistleblowers, and the entity's policies and procedures ...

...n 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.

... of the following: (1) Disproportionately impacts the ability of medicaid recipients with chronic illnesses to obtain medically necessary medicaid services; (2) Violates section 5164.09 or 5164.10 of the Revised Code. (B)(1) No provider shall refuse to provide a service to a medicaid recipient who is unable to pay a required copayment for the service. (2) Division (B)(1) of this section shall not be considere...