Ohio Revised Code Search

...e the program or to avoid an extended delay in the secretary's approval, the medicaid director shall make the change or removal. The change or removal may cause the medicaid buy-in for workers with disabilities program to include a provision that is inconsistent with sections 5163.09 to 5163.096 of the Revised Code. Such a change or removal shall be made only to the extent necessary to obtain the United States ...

...egarded in determining asset and income eligibility limits for the program; (2) Establish meanings for the terms "earned income," "health insurance," "resources," "spouse," and "unearned income"; (3) Establish additional eligibility requirements for the program that must be established for the United States secretary of health and human services to approve the program ; (B) The director may adopt rules under se...

...en option" means the option available under section 1920 of the "Social Security Act," 42 U.S.C. 1396r-1, to make ambulatory prenatal care available to pregnant women under the medicaid program during presumptive eligibility periods. ( 2) "Qualified provider" has the same meaning as in section 1920(b)(2) of the "Social Security Act," 42 U.S.C. 1396r-1(b)(2). (B) The medicaid director shall implement the presumptiv...

...of the Revised Code. (4) "Presumptive eligibility for children option" means the option available under section 1920A of the "Social Security Act," 42 U.S.C. 1396r-1a, to make medical assistance with respect to health care items and services available to children under the medicaid program during presumptive eligibility periods. (5) "Qualified entity" has the same meaning as in section 1920A(b)(3) of the "Social ...

...ch a qualified entity or qualified provider deems an individual presumptively eligible for medicaid under sections 5163.10 to 5163.102 of the Revised Code when the individual is ineligible for the medicaid program. (2) "Qualified entity" has the same meaning as in section 5163.101 of the Revised Code. (3) "Qualified provider" has the same meaning as in section 5163.10 of the Revised Code. (B) Notwithstanding...

...as in section 5163.103 of the Revised Code. Quarterly, the department of medicaid shall report to the general assembly the presumptive eligibility error rate for presumptive eligibility determinations made during the previous quarter. Reports made under this section shall be submitted to the general assembly in accordance with section 101.68 of the Revised Code.

...tment of medicaid shall redetermine the eligibility of members of the expansion eligibility group for medicaid benefits every six months.

...ant to section 5815.28 of the Revised Code, then, notwithstanding any contrary provision of this chapter or of a rule adopted under section 5163.02 of the Revised Code, divisions (C) and (D) of that section shall apply in determining the assets or resources of the recipient, the recipient's estate, the settlor, or the settlor's estate and to claims arising under this chapter against the recipient, the recipient...

...er shall be considered an improper disposition of assets and shall be subject to section 5163.30 of the Revised Code and rules to implement that section adopted under section 5163.02 of the Revised Code. (6) The baseline date for the look-back period for disposition of assets involving a medicaid qualifying trust shall be the date on which the applicant or recipient is both institutionalized and first applies for m...

...be considered a resource in determining eligibility for the medicaid program shall be excluded from any determination of a person's eligibility for the medicaid program if the owner designates the department of medicaid as beneficiary of the policy. The department may pay premiums to keep the policy in force. Premiums paid by the department are medicaid payments correctly paid on behalf of a medicaid recipient ...

...or whom a payment is made based on a level of care provided in a nursing facility, or an individual described in the "Social Security Act," section 1902(a)(10)(A)(ii)(VI), 42 U.S.C. 1396a(a)(10)(A)(ii)(VI). (4) "Look-back date" means the date that is a number of months specified in rules adopted under section 5163.02 of the Revised Code immediately before either of the following: (a) The date an individual become...

...aged, blind, or disabled individual is eligible for nursing facility services, ICF/IID services, or other medicaid-funded long-term care services, the medicaid director may consider an aged, blind, or disabled individual's real property to not be the individual's homestead or principal place of residence once the individual has resided in a nursing facility, ICF/IID, or other medical institution for at least t...

...(A) Except as otherwise provided by this section, no individual shall qualify for nursing facility services or other medicaid-funded long-term care services if the individual's equity interest in the individual's home exceeds five hundred thousand dollars. The medicaid director shall increase this amount effective January 1, 2011, and the first day of each year thereafter, by the percentage increase in the cons...

... available to each other in determining eligibility. (C) In the case of a resident of an ICF/IID, the monthly personal needs allowance shall be as follows: (1) Prior to January 1, 2016, forty dollars unless the resident has earned income, in which case the monthly personal needs allowance shall be determined by the department of medicaid, or the department's designee, but shall not exceed one hundred five dollars; ...

... necessary for making determinations of eligibility for the component, except that the form may require applicants to provide their social security numbers. The form shall include a statement, which must be signed by the applicant, indicating that she does not choose at the time of making application for the component to apply for assistance provided under any other program administered by the department or the...

...) A correctional facility that is privately operated and managed pursuant to section 9.06 of the Revised Code. (2) "State or local correctional facility" does not include any facility operated directly by or at the direction of the department of youth services. (B) If a person who is confined in a state or local correctional facility was a medicaid recipient immediately prior to being confined in the facility,...

...s in other states; (6) Household composition; (7) Medicaid enrollee incarceration status; (8) Third-party liability verification; (9) Asset verification; (10) Any other records or systems the department considers appropriate in order to strengthen program integrity, reduce costs, and reduce fraud, waste, and abuse in the medicaid program. (B) As part of the considerations under division (A) of this sectio...

.... (K) "ICDS participant" means a dual eligible individual who participates in the integrated care delivery system. (L) "ICF/IID" has the same meaning as in section 5124.01 of the Revised Code. (M) "Integrated care delivery system" and "ICDS" mean the demonstration project authorized by section 5164.91 of the Revised Code. (N) "Mandatory services" means the health care services and items that must be covered b...

...ance with Chapter 119. of the Revised Code. (B) The rules shall establish all of the following: (1) The amount, duration, and scope of the medicaid services covered by the medicaid program; (2) The medicaid payment rate for each medicaid service or, in lieu of the rate, the method by which the rate is to be determined for each medicaid service; (3) Procedures for enforcing the rules adopted under this section tha...

...(A) The medicaid program shall cover all mandatory services. (B) The medicaid program shall cover all of the optional services that state statutes require the medicaid program to cover. (C) The medicaid program may cover any of the optional services to which either of the following applies: (1) State statutes expressly permit the medicaid program to cover the optional service; (2) State statutes do not addr...

...ver occupational therapy services provided by an occupational therapist licensed under section 4755.08 of the Revised Code. Coverage shall not be limited to services provided in a hospital or nursing facility. Any licensed occupational therapist may enter into a provider agreement with the department of medicaid to provide occupational therapy services under the medicaid program.

... as in section 4729.01 of the Revised Code, but does not include a dentist, optometrist, or veterinarian. (2) "Prior authorization requirement" means any practice in which coverage of a health care service, device, or drug is dependent upon a recipient or health care practitioner obtaining approval from the medicaid program prior to the service, device, or drug being performed, received, or prescribed, as applicabl...

...atient care following a normal vaginal delivery and a minimum of ninety-six hours of inpatient care following a cesarean delivery. Services covered as inpatient care shall include medical, educational, and any other services that are consistent with the inpatient care recommended in the protocols and guidelines developed by national organizations that represent pediatric, obstetric, and nursing professionals. (2) Th...

... as in section 4723.89 of the Revised Code. (B) The medicaid program shall cover doula services that are provided by a doula if the doula has a valid provider agreement and is certified under section 4723.89 of the Revised Code. Medicaid payments for doula services shall be determined on the basis of each pregnancy, regardless of whether multiple births occur as a result of that pregnancy. (C) Any provider outcom...

...tationally corrected age is less than twelve months when all of the following apply: (1) A licensed health professional signs an order stating that human donor milk or human milk fortifiers are medically necessary because the infant meets any of the following criteria: (a) The infant has a birth weight less than eighteen hundred grams or body weight below healthy levels. (b) The infant has a gestational age ...