Ohio Revised Code Search

...r 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" includes a governmental entity or an organization, unit, corporation, partnership, or other business arrangement, including any medicaid managed care organi...

...ide coverage of the cost of health care services to a child eligible for medicaid. (2) The person has received payment from a third party for the costs of such services but has not used the payment to reimburse either the other parent or guardian of the child or the provider of the services. (C) Claims for current and past due child support shall take priority over claims under division (B) of this section.

...partment of mental health and addiction services under section 5162.35 of the Revised Code is subject to the approval of the director of budget and management and shall require or specify all of the following: (A) That section 5162.371 of the Revised Code be complied with; (B) How providers will be paid for providing the services; (C) The responsibilities of the department of mental health and addiction servic...

...vidual 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 thirteen months. (B) Division...

...dual 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 consumer price index for all urban consumers (all items; United...

... 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 outcome measurements or incentives the department of me...

...edicaid 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 in ac...

...im for medicaid payment for a medicaid service provided by a physician assistant to a medicaid recipient may be submitted by the physician assistant who provided the service or the physician, group practice, clinic, or other health care facility that employs the physician assistant. (2) A claim for medicaid payment may be submitted by the physician assistant who provided the service only if the physician assi...

... (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 medicaid recipients duri...

...op payment to the provider for medicaid services rendered from the date of conviction or entry of judgment. No such medicaid provider, owner, officer, authorized agent, associate, manager, or employee shall own or provide medicaid services on behalf of any other medicaid provider or risk contractor or arrange for, render, or order medicaid services for medicaid recipients, nor shall such provider, owner, officer, aut...

... make summary data regarding perinatal services available on request to local organizations concerned with infant mortality reduction initiatives and recipients of grants administered by the division of family and community health services in the department of health.

... shall not be paid for nursing facility services provided to low case-mix residents. Instead, the total rate for such nursing facility services shall be one hundred fifteen dollars per medicaid day.

... shall not be paid for nursing facility services provided by a nursing facility, or discrete unit of a nursing facility, designated by the department of medicaid as an outlier nursing facility or unit. Instead, the provider of a designated outlier nursing facility or unit shall be paid each state fiscal year a total per medicaid day payment rate that the department shall prospectively determine in accordance with a m...

...cords documenting the costs of medicaid services provided under the home and community-based services medicaid waiver components that the agency administers, including records of independent audits. The administrative agency shall make the financial records available on request to the United States secretary of health and human services, United States comptroller general, and their designees.

... individual received inpatient hospital services for at least fourteen consecutive days, or had at least three inpatient hospital stays during the twelve months, immediately preceding the date the individual applies for the Ohio home care waiver program. (2) If the individual is at least twenty-one but less than sixty years of age, the individual received inpatient hospital services for at least fourteen consec...

...ividual 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 all of the following: (1) That the individual either meets the personnel qualifications specified i...

...ical, 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 participant's buckeye account is zero. (C) It shall require copayments for services covered by the health plan, except that a participant's copayments shall be waived whenever the amount of the core portion of the partici...

... 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.

... on behalf of a community mental health services provider whose mental health services are certified by the department of mental health and addiction services under section 5119.36 of the Revised Code; (c) A certified nurse practitioner, as defined in section 4723.01 of the Revised Code, who is certified in psychiatric mental health by a national certifying organization approved by the board of nursing under secti...

... shall provide enhanced care management services for pregnant women and women capable of becoming pregnant in the communities specified in rules adopted under section 3701.142 of the Revised Code. The services shall be provided in a manner intended to decrease the incidence of prematurity, low birth weight, and infant mortality, as well as improve the overall health status of women capable of becoming pregnant for th...

...anization's enrollee receives emergency services on or after January 1, 2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the amounts (less any payments for indirect costs of medical education and direct costs of graduate medical education) that the provider could collect if the enrollee received medicaid other th...

...t to the hospital of providing hospital services for the organization, payments made by the organization to the hospital for the services, utilization of hospital services by the organization's enrollees, and other utilization data required by the department.

...tates centers for medicare and medicaid services pursuant to division (D) of this section. (B) Not later than fourteen days after the preliminary determinations are issued, any hospital may submit to the department a written request to reconsider the preliminary determinations. The request shall be accompanied by written materials setting forth the basis for the reconsideration, which may be delivered to the depar...

...n 3701.023 of the Revised Code; (iv) Services provided under the maternal and child health services block grant established under Title V of the "Social Security Act," 42 U.S.C. 701 et seq. (b) Any other category of hospital costs the director deems appropriate under federal law and regulations governing the medicaid program. (2) Subject to division (C) of this section, provide for the percentage of hospital...

...d States secretary of health and human services for a waiver under the "Social Security Act," section 1903(w)(3)(E), 42 U.S.C. 1396b(w)(3)(E), as necessary to do both of the following regarding the franchise permit fee assessed under section 5168.42 of the Revised Code: (1) Reduce the franchise permit fee rate to zero dollars for each nursing home licensed under section 3721.02 or 3721.09 of the Revised Code...