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Ohio Statutes, Title 51

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Ohio/Statutes

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Title 51, Title 51. Public Welfare

31 chapters · 1,983 sections in this title.

All chapters in Title 511,983 Ch 5123, Chapter 5123 | Department of Develop…182 Ch 5101, Chapter 5101 | Department of Job and…144 Ch 5119, Chapter 5119 | Department of Behavio…121 Ch 5120, Chapter 5120 | Department of Rehabil…121 Ch 5165, Chapter 5165 | Medicaid Coverage of …116 Ch 5103, Chapter 5103 | Placement of Children113 Ch 5126, Chapter 5126 | County Boards of Deve…111 Ch 5180, Chapter 5180 | Department of Childre…94 Ch 5164, Chapter 5164 | Medicaid State Plan S…92 Ch 5124, Chapter 5124 | Intermediate Care Fac…80 Ch 5153, Chapter 5153 | County Children Services72 Ch 5104, Chapter 5104 | Child Day-care69 Ch 5168, Chapter 5168 | Hospital Care Assuran…66 Ch 5107, Chapter 5107 | Ohio Works First Program64

92 sections·Filtered byTitle 51✕Ch 5164✕

Ohio Rev. Code Ann. § 5164.01 Definitions
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As used in this chapter: (A) "Adjudication" has the same meaning as in section 119.01 of the Revised Code. (B) "Behavioral health redesign" means revisions to the medicaid program's coverage of community behavioral health services beginning July 1, 2017, including revisions that …
Ohio Rev. Code Ann. § 5164.02 Rules to implement chapter
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(A) The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance 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 cover…
Ohio Rev. Code Ann. § 5164.03 Mandatory and optional services
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(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 followin…
Ohio Rev. Code Ann. § 5164.06 Medicaid coverage of occupational therapy services
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The medicaid program shall cover 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 e…

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Ohio Rev. Code Ann. § 5164.061 Chiropractic services

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(A) As used in this section: (1) "Prescriber" has the same meaning 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,…

Ohio Rev. Code Ann. § 5164.07 Coverage of inpatient care and follow-up care for a mother and her newborn

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(A) The medicaid program shall include coverage of inpatient care and follow-up care for a mother and her newborn as follows:(1) The medicaid program shall cover a minimum of forty-eight hours of inpatient care following a normal vaginal delivery and a minimum of ninety-six hours…

Ohio Rev. Code Ann. § 5164.071 Doula program

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(A) As used in this section, "doula" has the same meaning 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 …

Ohio Rev. Code Ann. § 5164.072 Coverage of donor breast milk and fortifiers

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(A) As used in this section, "licensed health professional" means the following: (1) A physician authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery; (2) An advanced practice registered nurse who holds a current,…

Ohio Rev. Code Ann. § 5164.08 Breast cancer and cervical cancer screening

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(A) As used in this section: (1) "Screening mammography" means a radiologic examination utilized to detect unsuspected breast cancer at an early stage in asymptomatic women and includes the x-ray examination of the breast using equipment that is dedicated specifically for mammogr…

Ohio Rev. Code Ann. § 5164.09 Equivalent coverage for orally and intravenously administered cancer medications

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(A) Except as provided in division (C) of this section, the medicaid program shall cover prescribed, orally administered cancer medications on at least the same basis that it covers intraveneously administered or injected cancer medications. In implementing this section, the depa…

Ohio Rev. Code Ann. § 5164.091 Coverage for opioid analgesics

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(A) As used in this section:(1) "Benzodiazepine" has the same meaning as in section 3719.01 of the Revised Code.(2) "Chronic pain" has the same meaning as in section 4731.052 of the Revised Code.(3) "Hospice care program" and "hospice patient" have the same meanings as in section…

Ohio Rev. Code Ann. § 5164.092 Coverage of remote ultrasounds and fetal nonstress tests

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(A) Except as provided in division (B) of this section, the medicaid program shall cover remote ultrasound procedures and remote fetal nonstress tests, utilizing established current procedural terminology codes (CPT codes) for those procedures for when the patient is in a residen…

Ohio Rev. Code Ann. § 5164.093 Coverage of rapid whole genome sequencing

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(A) As used in this section, "rapid whole genome sequencing" means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes, and includes patient-only whole genome seq…

Ohio Rev. Code Ann. § 5164.10 Coverage of tobacco cessation medications and services

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(A) The medicaid program shall cover both of the following, subject to division (C) of this section: (1) All tobacco cessation medications approved by the United States food and drug administration; (2) All forms of tobacco cessation services recommended by the United States prev…

Ohio Rev. Code Ann. § 5164.14 Medicaid coverage for health care service provided by pharmacist

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The medicaid 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 o…

Ohio Rev. Code Ann. § 5164.15 Mental health services

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(A) As used in this section: (1) "Community mental health services provider or facility" means a community mental health services provider or facility that has its community mental health services certified by the department of mental health and addiction services under section 5…

Ohio Rev. Code Ann. § 5164.16 Coverage of one or more state plan home and community-based services

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The medicaid program may cover one or more state plan home and community-based services that the department of medicaid selects for coverage. A medicaid recipient of any age may receive a state plan home and community-based service if the recipient has countable income not exceed…

Ohio Rev. Code Ann. § 5164.17 Medicaid coverage of tobacco cessation services

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The medicaid program may cover tobacco cessation services in addition to the services that must be covered under section 5164.10 of the Revised Code or may exclude coverage of additional tobacco cessation services.

Ohio Rev. Code Ann. § 5164.20 Medicaid not to cover drugs for erectile dysfunction

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The medicaid program shall not cover prescribed drugs for treatment of erectile dysfunction.

Ohio Rev. Code Ann. § 5164.25 Recipient with developmental disability who is eligible for medicaid case management services

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The departments of developmental disabilities and medicaid may approve, reduce, deny, or terminate a medicaid service included in the individual service plan developed for a medicaid recipient with a developmental disability who is eligible for medicaid case management services. …

Ohio Rev. Code Ann. § 5164.26 Healthcheck component

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The department of medicaid shall establish a combination of written and oral methods designed to provide information about healthcheck to all persons eligible for the program or their parents or guardians. The department shall ensure that its methods of providing information are …

Ohio Rev. Code Ann. § 5164.29 Revised Medicaid provider enrollment system

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Not later than December 31, 2018, the department of medicaid shall develop and implement revisions to the system by which persons and government entities become and remain medicaid providers so that there is a single system of records for the system and the persons and government…

Ohio Rev. Code Ann. § 5164.291 Provider credentialing committee

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The department of medicaid shall establish a credentialing program that includes a credentialing committee to review the competence, professional conduct, and quality of care provided by medicaid providers. Any activities performed by the credentialing committee shall be consider…

Ohio Rev. Code Ann. § 5164.30 Provider agreement with department required

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No person or government entity may participate in the medicaid program as a medicaid provider without a valid provider agreement with the department of medicaid.

Ohio Rev. Code Ann. § 5164.301 Medicaid provider agreements for physician assistants

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(A) As used in this section, "group practice" has the same meaning as in section 4731.65 of the Revised Code. (B) The department of medicaid shall establish a process by which a physician assistant may enter into a provider agreement.(C)(1) Subject to division (C)(2) of this sect…

Ohio Rev. Code Ann. § 5164.31 Funding for implementing the provider screening requirements

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(A) For the purpose of raising funds necessary to pay the expenses of implementing the provider screening requirements of subpart E of 42 C.F.R. Part 455 and except as provided in division (B) of this section, the department of medicaid shall collect an application fee from a med…

Ohio Rev. Code Ann. § 5164.32 Expiration of medicaid provider agreements

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(A) Each medicaid provider agreement shall expire not later than five years from its effective date. If a provider agreement entered into before the effective date of this amendment does not have a time limit, the department of medicaid shall convert the agreement to a provider a…

Ohio Rev. Code Ann. § 5164.33 Denying, terminating, and suspending provider agreements

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(A) The medicaid director may do the following for any reason permitted or required by federal law and when the director determines that the action is in the best interests of medicaid recipients or the state: (1) Deny, refuse to revalidate, suspend, or terminate a provider agree…

Ohio Rev. Code Ann. § 5164.34 Criminal records check of provider personnel, owners and officers

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(A) As used in this section: (1) "Criminal records check" has the same meaning as in section 109.572 of the Revised Code. (2) "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. (3) "Owner" me…

Ohio Rev. Code Ann. § 5164.341 Criminal records check by independent provider

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(A) As used in this section: "Anniversary date" means the effective date of the provider agreement relating to the independent provider. "Applicant" means a person who has applied for a provider agreement to provide home and community-based services as an independent provider und…

Ohio Rev. Code Ann. § 5164.342 Criminal records checks by waiver agencies

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(A) As used in this section: "Applicant" means a person who is under final consideration for employment with a waiver agency in a full-time, part-time, or temporary position that involves providing home and community-based services. "Community-based long-term care provider" means…

Ohio Rev. Code Ann. § 5164.35 Provider offenses

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(A) As used in this section, "owner" means any person having at least five per cent ownership in a medicaid provider. (B)(1) No medicaid provider shall do any of the following: (a) By deception, obtain or attempt to obtain payments under the medicaid program to which the provider…

Ohio Rev. Code Ann. § 5164.36 Credible allegation of fraud or disqualifying indictment; suspension of provider agreement

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(A) As used in this section: (1) "Credible allegation of fraud" has the same meaning as in 42 C.F.R. 455.2, except that for purposes of this section any reference in that regulation to the "state" or the "state medicaid agency" means the department of medicaid. (2) "Disqualifying…

Ohio Rev. Code Ann. § 5164.37 Suspension of provider agreement without notice

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(A) The department of medicaid may suspend a medicaid provider's provider agreement without prior notice if the department has evidence that the provider presents a danger of immediate and serious harm to the health, safety, or welfare of medicaid recipients. The department also …

Ohio Rev. Code Ann. § 5164.38 Adjudication orders of department

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(A) As used in this section: (1) "Party" has the same meaning as in division (G) of section 119.01 of the Revised Code. (2) "Revalidate" means to approve a medicaid provider's continued enrollment as a medicaid provider in accordance with the revalidation process established in r…

Ohio Rev. Code Ann. § 5164.39 Hearing not required unless timely requested

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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 Revi…

Ohio Rev. Code Ann. § 5164.44 Employee status of independent provider

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(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 m…

Ohio Rev. Code Ann. § 5164.45 Contracts for examination, processing, and determination of medicaid claims

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(A) The department of medicaid may contract with any person or persons as a fiscal agent for the examination, processing, and determination of medicaid claims. The contracting party may provide any of the following services, as required by the contract: (1) Design and operate med…

Ohio Rev. Code Ann. § 5164.46 Electronic claims submission process; electronic fund transfers

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(A) As used in this section, "electronic claims submission process" means any of the following: (1) Electronic interchange of data;(2) Direct entry of data through an internet-based mechanism implemented by the department of medicaid;(3) Any other process for the electronic submi…

Ohio Rev. Code Ann. § 5164.47 Contracting for review and analysis, quality assurance and quality review

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(A) As used in this section, "OCHSPS" means the private, not-for-profit corporation known as the Ohio children's hospital solutions for patient safety, which was formed for the purpose of improving pediatric patient care in this state, which performs functions that are included w…

Ohio Rev. Code Ann. § 5164.471 Summary data regarding perinatal services

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Not less than once each year and in accordance with all state and federal laws governing the confidentiality of patient-identifying information, the department of medicaid shall make summary data regarding perinatal services available on request to local organizations concerned w…

Ohio Rev. Code Ann. § 5164.48 Medicaid payments made to organization on behalf of providers

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The medicaid director may implement a system under 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 pr…

Ohio Rev. Code Ann. § 5164.55 Final fiscal audits

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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 …

Ohio Rev. Code Ann. § 5164.56 Lien for amount owed by provider

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Under the medicaid program, any amount determined to be owed the state by a final fiscal audit conducted pursuant to section 5164.55 of the Revised Code, upon the issuance of an adjudication order pursuant to Chapter 119. of the Revised Code that contains a finding that there is …

Ohio Rev. Code Ann. § 5164.57 Recovery of medicaid overpayments

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(A)(1) Except as provided in division (A)(2) of this section, the department of medicaid may recover a medicaid payment or portion of a payment made to a medicaid provider to which the provider is not entitled if the department notifies the provider of the overpayment during the …

Ohio Rev. Code Ann. § 5164.58 Agency action to recover overpayment to provider

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(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 t…

Ohio Rev. Code Ann. § 5164.59 Deduction of incorrect payments

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The department of medicaid may deduct 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.

Ohio Rev. Code Ann. § 5164.60 Interest on Medicaid provider excess payments

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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…

Ohio Rev. Code Ann. § 5164.61 Scope of available remedies for recovery of excess payments

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The authority, under state and federal law, of the department of medicaid or 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 Rev…

Ohio Rev. Code Ann. § 5164.70 Limitations on medicaid payments for services

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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.