Title 51, Title 51. Public Welfare

No third party shall consider whether an individual is eligible for or enrolled in a medical assistance program when either of the following applies: (A) The individual seeks to obtain a policy or enroll in a plan or program operated or administered by the third party;(B) The ind…

(A) If a third party violates section 5160.39, 5160.40, or 5160.41 of the Revised Code, a governmental entity that is responsible for issuing a license, certificate of authority, registration, or approval that authorizes the third party to do business in this state may impose a f…

(A) The medicaid director may adopt rules under section 5160.02 of the Revised Code to implement sections 5160.35 to 5160.43 of the Revised Code, including rules that specify what constitutes cooperating with efforts to obtain support or payments, or medical assistance payments, …

(A) As used in sections 5160.45 to 5160.481 of the Revised Code, "information" means all of the following: (1) Records, as defined in section 149.011 of the Revised Code;(2) Any other documents in any format;(3) Data derived from records and documents that are generated, acquired…

(A) For the purposes of section 5160.45 of the Revised Code, an authorization shall be made on a form that uses language understandable to the average person and contains all of the following: (1) A description of the information to be used or disclosed that identifies the inform…

(A) The department of medicaid shall do both of the following:(1) Enter into any necessary agreements with the United States department of health and human services and neighboring states to join and participate as an active member in the public assistance reporting information s…

(A) As used in this section:"Federal military-related health care benefits" means any of the health care benefits provided by the United States department of defense or the United States department of veterans affairs to current or former service members and their eligible depend…

(A) The medicaid director shall adopt rules under section 5160.02 of the Revised Code implementing sections 5160.45 to 5160.481 of the Revised Code and governing the custody, use, disclosure, and preservation of the information generated or received by the department of medicaid,…

Whenever names, addresses, or other information relating to medical assistance recipients is held by any agency other than the department of medicaid or a county department of job and family services, that other agency shall adopt rules consistent with sections 5160.45 to 5160.48…

The department of medicaid shall administer the refugee medical assistance program authorized by the "Immigration and Nationality Act," section 412(e), 8 U.S.C. 1522(e).

The medicaid director may provide for the department of medicaid to develop, participate in the development of, negotiate, and enter into one or more interstate compacts on behalf of this state with agencies of any other states, for the provision of medical assistance to children…

Whoever violates division (B) of section 5160.45 of the Revised Code is guilty of a misdemeanor of the first degree.

(A) As used in the Revised Code, "children's health insurance program" and, when used as an acronym for the children's health insurance program, "CHIP" mean the program of child health assistance authorized by Title XXI of the "Social Security Act," 42 U.S.C. 1397aa et seq. CHIP …

The medicaid director may adopt rules in accordance with Chapter 119. of the Revised Code as necessary for the efficient administration of the children's health insurance program, including rules that establish all of the following: (A) The conditions under which the program will…

The medicaid director may continue to operate the component of the children's health insurance program initially authorized by an executive order issued under section 107.17 of the Revised Code as long as federal financial participation is available for the program. If operated, …

The component of the children's health insurance program authorized by section 5161.05 of the Revised Code shall be known as CHIP part I.

In accordance with federal law governing the children's health insurance program, the medicaid director may submit a state child health plan to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for part or …

The component of the children's health insurance program authorized by section 5161.10 of the Revised Code shall be known as CHIP part II.

If the medicaid director submits a state child health plan to the United States secretary of health and human services under section 5161.10 of the Revised Code and the secretary approves the plan, the director shall implement CHIP part II in accordance with the plan. ; .

In accordance with federal law governing the children's health insurance program, the medicaid director may submit a request for a federal waiver to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for par…

The component of the children's health insurance program authorized by section 5161.15 of the Revised Code shall be known as CHIP part III.

If the medicaid director submits a waiver request to the United States secretary of health and human services under section 5161.15 of the Revised Code and the secretary grants the waiver, the director shall implement CHIP part III in accordance with the waiver.

In accordance with the "Social Security Act," section 2101, 42 U.S.C. 1397aa, the children's health insurance program shall provide payments for obtaining health benefits coverage through any of the following: (A) Obtaining coverage that meets the requirements the "Social Securit…

If the medicaid director determines that federal financial participation for CHIP part II, part III, or both parts is insufficient to pay for part or all of the costs of health benefits coverage for all the individuals the director anticipates are eligible for the part or parts, …

To the extent permitted by the "Social Security Act," section 2103(e), 42 U.S.C. 1397cc(e), the medicaid director may require an individual seeking to enroll, or who is enrolled, in CHIP part II to pay a premium, deductible, coinsurance payment, or other cost-sharing expense.

To the extent permitted by the "Social Security Act," section 2103(e), 42 U.S.C. 1397cc(e), the medicaid director shall require an individual seeking to enroll, or who is enrolled, in CHIP part III to pay the following as a term of enrollment: (A) A premium of not less than forty…

A completed application for medicaid shall be treated as an application for the children's health insurance program if the application is for an assistance group that includes a child under nineteen years of age and is denied.

The medicaid director may contract with a government entity or person to perform the director's administrative duties regarding CHIP part I, part II, part III, two of the parts, or all three parts, other than the duty to submit a state child health plan to the United States secre…

(A) The medicaid director may submit a waiver request to the United States secretary of health and human services to provide health assistance to any individual who meets all of the following requirements: (1) Is the parent of a child who is under nineteen years of age, resides w…

(A) As used in the Revised Code: (1) "Medicaid" and "medicaid program" mean the program of medical assistance established by Title XIX of the "Social Security Act," 42 U.S.C. 1396 et seq., including any medical assistance provided under the medicaid state plan or a federal medica…

The medicaid director shall adopt rules as necessary to implement this chapter.

The medicaid director shall adopt rules under sections 5160.02, 5162.02, 5163.02, 5164.02, 5165.02, 5166.02, and 5167.02 of the Revised Code as necessary to authorize the directors of other state agencies to adopt rules regarding medicaid components, or aspects of medicaid compon…

The medicaid director's rules governing medicaid are binding on other state agencies and political subdivisions that administer one or more components of the medicaid program, or one or more aspects of a component, pursuant to contracts entered into under section 5162.35 of the R…

For the purpose of the "Social Security Act," section 1902(a)(5), 42 U.S.C. 1396a(a)(5), the department of medicaid shall act as the single state agency to supervise the administration of the medicaid program. As the single state agency, the department shall comply with 42 C.F.R.…

(A) The medicaid director may do all of the following as necessary for the department of medicaid to fulfill the duties it has, as the single state agency for the medicaid program, under the "Medicare Prescription Drug, Improvement, and Modernization Act of 2003" Pub. L. No. 108-…

As used in this section, "state agency" has the same meaning as in section 9.23 of the Revised Code. No provision of Title LI of the Revised Code or any other law of this state that incorporates any provision of federal medicaid law, or that may be construed as requiring the stat…

The medicaid program shall be implemented in accordance with all of the following: (A) The medicaid state plan approved by the United States secretary of health and human services, including amendments to the plan approved by the United States secretary;(B) Federal medicaid waive…

(A) Notwithstanding any other state statute except for section 5164.061 of the Revised Code, no component, or aspect of a component, of the medicaid program shall be implemented without all of the following: (1) Subject to division (B) of this section, if the component, or aspect…

The medicaid director shall seek federal approval for all components, and aspects of components, of the medicaid program for which federal approval is needed, except that the director is permitted rather than required to seek federal approval for components, and aspects of compon…

(A) Notwithstanding any provision of law to the contrary, and in accordance with section 5166.03 of the Revised Code, the department of medicaid shall not seek or implement an amendment to the medicaid state plan or a medicaid waiver under section 1115 or 1915 of the "Social Secu…

The medicaid director may conduct reviews of the medicaid program. The reviews may include physical inspections of records and sites where medicaid services are provided and interviews of medicaid providers and medicaid recipients. If the director determines pursuant to a review …

(A) The department of medicaid shall enter into an agreement with the department of administrative services for the department of administrative services to contract through competitive selection pursuant to section 125.07 of the Revised Code with a vendor to perform an assessmen…

(A) The medicaid director shall enter into a contract with one or more persons to receive and process, on the director's behalf, requests for medicaid recipient or claims payment data, data from reports of audits conducted under section 5165.109 of the Revised Code, or extracts o…

(A) On or before the first day of January of each year, the department of medicaid shall complete a report on the effectiveness of the medicaid program in meeting the health care needs of low-income pregnant women, infants, and children. The report shall include all of the follow…

(A) The department of medicaid shall periodically evaluate the success that members of the expansion eligibility group have with the following: (1) Obtaining employer-sponsored health insurance coverage; (2) Improving health conditions that would otherwise prevent or inhibit stab…

(A) Not later than the thirty-first day of December of each year, the department of medicaid shall prepare a report on the department's efforts to minimize fraud, waste, and abuse in the medicaid program. The report shall include all of the following for the most recently conclud…