Ohio Revised Code Search

...e 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, all of the following apply: (1) The person's eligibility for medicaid while so confined shall be suspended due to the confinement. (2) No medicaid payment shall be made for any care, services, or supplies provid...

...d payments to the medicaid provider for services rendered, regardless of the date that the services were rendered, when the department suspends the provider agreement under this section. (B) If the department suspends a medicaid provider's provider agreement under this section, the department shall do both of the following: (1) Not later than five days after suspending the provider agreement, notify the medicaid ...

...d States department of health and human services and that action is binding on the provider's medicaid participation. (5) The medicaid provider's provider agreement and medicaid payments to the provider are suspended under section 5164.36 or 5164.37 of the Revised Code. (6) The medicaid provider's application for a provider agreement is denied because the provider's application was not complete; (7) The medi...

...n, no medicaid payment for any medicaid service provided by a hospital, nursing facility, or ICF/IID shall exceed the limits established under Subpart C of 42 C.F.R. Part 447.

...e, or certified nurse practitioner for services performed by the nurse shall be determined and agreed on by the nurse and collaborating physician or podiatrist. In no case shall the medicaid payment exceed the medicaid payment that the physician or podiatrist would have received had the physician or podiatrist provided the entire service.

...ducation costs associated with medicaid services rendered to medicaid recipients. Subject to section 5164.741 of the Revised Code, the rules shall provide for payment of graduate medical education costs associated with medicaid services rendered to medicaid recipients, including recipients enrolled in a medicaid managed care organization, that the department of medicaid determines are allowable and reasonable.

...evised Code to implement a coordinated services program for medicaid recipients who are found to have obtained prescribed drugs under the medicaid program at a frequency or in an amount that is not medically necessary. The program shall be implemented in a manner that is consistent with the "Social Security Act," section 1915(a)(2), 42 U.S.C. 1396n(a)(2), and 42 C.F.R. 431.54(e).

... determine whether or not a health care service or drug is appropriate and consistent with medical or scientific evidence. (3) "Medical or scientific evidence" has the same meaning as in section 3922.01 of the Revised Code. (4) "Step therapy exemption" means an overriding of a step therapy protocol in favor of immediate coverage of a medicaid provider's selected prescription drug. (5) "Step therapy protocol" m...

...urs for requests related to urgent care services; (b) Ten calendar days for all other requests. (2)(a) If an exemption request is denied, a medicaid provider may appeal the denial on behalf of the medicaid recipient. (b) From the time a step therapy appeal is received, the department shall either grant or deny the appeal within the following time frames: (i) Forty-eight hours for appeals related to urgent ...

... changes to payment rates for medicaid services, the medicaid director shall give public notice in the register of Ohio of any change to a method or standard used to determine the medicaid payment rate for a medicaid service.

...edicaid provider that provides medicaid services under the integrated care delivery system. The director shall create standardized claim codes to be used on the standardized claim forms. Each medicaid provider and medicaid provider's designee that bills for medicaid services provided under the integrated care delivery system shall use the appropriate standardized claim form and standardized claim codes.

...medicaid providers to provide medicaid services to medicaid recipients in culturally and linguistically appropriate manners.

...artment of mental health and addiction services under section 5119.40 of the Revised Code or by the department of developmental disabilities under section 5123.021 of the Revised Code. If the individual is an applicant for or recipient of medicaid, the individual may appeal pursuant to section 5160.31 of the Revised Code. If the individual is not an applicant for or recipient of medicaid, the individual may ap...

...e the initial rate for nursing facility services provided by a new nursing facility. Instead, the initial total per medicaid day payment rate for nursing facility services provided by a new nursing facility shall be determined in the following manner: (1) The initial rate for ancillary and support costs shall be the rate for the new nursing facility's peer group determined under division (C) of section 5165.16 of ...

... shall not be paid for nursing facility services that a nursing facility not designated as an outlier nursing facility or unit provides to a resident who meets the criteria for admission to a designated outlier nursing facility or unit, as specified in rules authorized by section 5165.153 of the Revised Code. Instead, the provider of a nursing facility providing nursing facility services to such a resident shall be p...

... States department of health and human services of the facility's compliance with the plan of correction. (F) If a provider's obligation to repay the department of medicaid under division (D) of this section results from disallowance of federal financial participation by the United States department of health and human services, the provider shall not be required to repay the department of medicaid until the f...

...untable for funds expended for medicaid services covered by the home and community-based services medicaid waiver components that the agency administers.

...r may create a home and community-based services medicaid waiver component as part of the integrated care delivery system. If the ICDS medicaid waiver component is created, both of the following apply: (1) The department of medicaid shall administer it; (2) When it begins to accept enrollments, no ICDS participant who is eligible for the ICDS medicaid waiver component shall be enrolled in an ODA or MCD medicaid...

...ver component, home and community-based services of the type and in at least the amount, duration, and scope that the participant is assessed to need and would have received if the participant were enrolled in an ODA or MCD medicaid waiver component.

...plete not less than twelve hours of in-service continuing education regarding home care attendant services each year and provide the appropriate director evidence satisfactory to the appropriate director that the attendant satisfied this requirement. The evidence shall be submitted to the appropriate director not later than the annual anniversary of the issuance of the home care attendant's initial provider ag...

... attendant provides home care attendant services in a manner that protects the consumer's privacy; (B) Participate in a face-to-face visit every ninety days with all of the following to monitor the health and welfare of each of the consumers to whom the attendant provides home care attendant services: (1) The consumer; (2) The consumer's authorized representative, if any; (3) A registered nurse who agrees...

...purposes regarding home care attendant services by submitting a written notice of the consumer's selection of an authorized representative to the appropriate director. The notice shall specifically identify the individual the consumer selects as authorized representative and may limit what the authorized representative may do on the consumer's behalf regarding home care attendant services. A consumer may not s...

... participant shall not receive medicaid services under the fee-for-service component of medicaid or participate in the care management system.

...penses under the policy for health care services and prescription drugs covered by the policy; (2) If the former participant has obtained health care coverage under an eligible employer-sponsored health plan, the former participant's out-of-pocket expenses under the plan for health care services and prescription drugs covered by the plan. (B) Only the amount remaining in a former healthy Ohio program participant's ...

...uirements regarding preventative health services for healthy Ohio program participants. The requirements may differ for participants of different ages and genders. (B) For the purpose of division (G)(2) of section 5166.402 of the Revised Code, authorize additional uses of a buckeye account and establish the means for using the account for those purposes. (C) For the purpose of division (A)(3) of section 5166.403 of...