Ohio Revised Code Search

...medicaid payments shall not be made for services or items the provider provides during the period beginning on the date the provider agreement expired and ending on the effective date of a subsequent provider agreement, if any, the department enters into with the provider.

... (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...

...ed in this division, "behavioral health services" means alcohol and drug addiction services, mental health services, or both. A medicaid provider of behavioral health services may choose to employ a person who the provider would be prohibited by division (D)(3) of this section from employing or would be required by division (H)(2) of this section to terminate the person's employment if both of the following apply:...

...ent to provide home and community-based services as an independent provider under a home and community-based medicaid waiver component administered by the department of medicaid. "Criminal records check" has the same meaning as in section 109.572 of the Revised Code. "Disqualifying offense" means any of the offenses listed or described in divisions (A)(3)(a) to (e) of section 109.572 of the Revised Code. "In...

...lves providing home and community-based services. "Community-based long-term care provider" means a provider as defined in section 173.39 of the Revised Code. "Community-based long-term care subcontractor" means a subcontractor as defined in section 173.38 of the Revised Code. "Criminal records check" has the same meaning as in section 109.572 of the Revised Code. "Disqualifying offense" means any of the ...

...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...

...from furnishing or billing for medicaid services under the medicaid program or relates to or results from performing management or administrative services relating to furnishing medicaid services under the medicaid program. (b) The indictment charges the person with committing an act that would constitute a disqualifying offense. (3) "Disqualifying offense" means any of the offenses listed or described in divis...

...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...

...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...

...A) As used in this section: (1) "Aide services" means all of the following: (a) Home health aide services covered by the medicaid program as part of the home health services benefit pursuant to 42 C.F.R. 440.70(b)(2); (b) Home care attendant services covered by a participating medicaid waiver component, as defined in section 5166.30 of the Revised Code; (c) Any of the following covered by a home and community...

... 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 be made upon claims for medicaid; (3) Prepare and furnish to the department lists and computer tapes of such claims for payment; (4) In addition to audits which may be conduc...

...aims for medicaid payment for medicaid services provided to medicaid recipients; (2) Arrange to receive medicaid payment from the department by means of electronic funds transfer. (C) Division (B) of this section does not apply to any of the following: (1) A nursing facility; (2) An ICF/IID; (3) A medicaid managed care organization; (4) Any other medicaid provider or type of medicaid provider designated in ...

...erform either or both of the following services, the director may contract with any qualified person, including OCHSPS, to perform the service or services on behalf of the department of medicaid: (1) Review and analyze claims for medicaid services provided to children in accordance with all state and federal laws governing the confidentiality of patient-identifying information; (2) Perform quality assurance an...

... 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.

...er which medicaid payments for medicaid services are made to an organization on behalf of medicaid providers. The system may not provide for an organization to receive an amount that exceeds, in aggregate, the amount the medicaid program would have paid directly to medicaid providers if not for this section.

...The department of medicaid may conduct final fiscal audits of medicaid providers in accordance with the applicable requirements set forth in federal laws and regulations and determine any amounts the provider may owe the state. When conducting final fiscal audits, the department shall consider generally accepted auditing standards, which include the use of statistical sampling.

... provider a base fee of one dollar for services and a housing trust fund fee of one dollar pursuant to section 317.36 of the Revised Code. In the event of a distribution of the provider's assets pursuant to an order of any court under the law of this state including any receivership, assignment for benefit of creditors, adjudicated insolvency, or similar proceedings, amounts then or thereafter due the state un...

...tates centers for medicare and medicaid services a completed, audited, medicare cost report for the provider that applies to the state fiscal year in which the overpayment was made. (B) Among the overpayments that may be recovered under this section are the following: (1) Payment for a medicaid service, or a day of service, not rendered; (2) Payment for a day of service at a full per diem rate that should have bee...

...(A) If a state agency that enters into a contract with the department of medicaid under section 5162.35 of the Revised Code identifies that a medicaid overpayment has been made to a medicaid provider, the state agency may commence actions to recover the overpayment on behalf of the department. (B) In recovering an overpayment pursuant to this section, a state agency shall comply with the following procedures: ...

...ct from medicaid payments for medicaid services rendered by a medicaid provider any amounts the provider owes the state as the result of incorrect medicaid payments the department has made to the provider.

...Any medicaid provider who, without intent, obtains payments under the medicaid program in excess of the amount to which the provider is entitled is liable for payment of interest on the amount of the excess payments for a period determined by the department, but not to exceed the period from the date on which payment was made to the date on which repayment is made to the state. The interest shall be paid at the avera...

... a county department of job and family services to recover excess medicaid payments made to a medicaid provider is not limited by the availability of remedies under sections 5162.21 and 5162.23 of the Revised Code for recovering benefits paid on behalf of medicaid recipients.

...Except as otherwise required by federal statute or regulation, 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.

...Medicaid payments for freestanding medical laboratory charges shall not exceed the customary and usual fee for laboratory profiles.