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Ohio Statutes, Title 51

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Ohio/Statutes

← All Ohio coverage

Title 51, Public Welfare

31 chapters · 2,012 sections in this title.

All chapters in Title 512,012 Ch 5123, Department of Developmental Disabilities182 Ch 5101, Department of Job and Family Service…145 Ch 5119, Department of Behavioral Health121 Ch 5120, Department of Rehabilitation and Cor…121 Ch 5165, Medicaid Coverage of Nursing Facilit…116 Ch 5103, Placement of Children113 Ch 5164, Medicaid State Plan Services113 Ch 5126, County Boards of Developmental Disab…111 Ch 5180, Department of Children and Youth94 Ch 5124, Intermediate Care Facility for Indiv…80 Ch 5153, County Children Services72 Ch 5104, Child Day-care69 Ch 5162, Medicaid and Medicaid Funds67 Ch 5168, Hospital Care Assurance Program; Hea…66

2,012 sections·Filtered byTitle 51✕

Ohio Rev. Code Ann. § 5162.1311 Billing codes annual report
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The department of medicaid shall prepare and submit an annual report to the general assembly in accordance with section 101.68 of the Revised Code that details any billing code that represents an increase or decrease of greater than fifty per cent in the utilization rate or total…
Ohio Rev. Code Ann. § 5162.132 Annual report outlining efforts to minimize fraud, waste, and abuse
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(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…
Ohio Rev. Code Ann. § 5162.133 Annual program report; distribution; contents
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Not less than once each year, the medicaid director shall submit a report on the medicaid buy-in for workers with disabilities program to the governor and the general assembly. The copy to the general assembly shall be submitted in accordance with section 101.68 of the Revised Co…
Ohio Rev. Code Ann. § 5162.134 Annual report of integrated care delivery system evaluation

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Not later than the first day of each July, the medicaid director shall complete a report of the evaluation conducted under section 5164.911 of the Revised Code regarding the integrated care delivery system. The director shall provide a copy of the report to the general assembly i…

Ohio Rev. Code Ann. § 5162.135 Infant mortality scorecard

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(A) As used in this section, "stillbirth" has the same meaning as in section 5180.12 of the Revised Code. (B) The department of medicaid shall create an infant mortality scorecard. The scorecard shall report all of the following: (1) The performance of the fee-for-service compone…

Ohio Rev. Code Ann. § 5162.136 Review of barriers to interventions intended to reduce tobacco use, prevent prematurity, and promote optimal birth spacing

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(A) The department of medicaid shall conduct periodic reviews to determine the barriers that medicaid recipients face in gaining full access to interventions intended to reduce tobacco use, prevent prematurity, and promote optimal birth spacing. The first review shall occur not l…

Ohio Rev. Code Ann. § 5162.137 Cost savings study

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Annually, the department of medicaid shall conduct a cost savings study of the medicaid program and prepare a report based on that study recommending measures to reduce costs under that program. The department shall submit its report to the governor.

Ohio Rev. Code Ann. § 5162.138 Program integrity annual report

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The department of medicaid shall annually prepare and submit a report to the chairpersons and ranking members of the committees of the house of representatives and senate with jurisdiction over medicaid detailing the department's efforts to ensure integrity within the medicaid pr…

Ohio Rev. Code Ann. § 5162.139 Electronic visit verification annual report

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(A) As used in this section, "electronic visit verification" or "EVV" has the same meaning as in section 1903(l) of the "Social Security Act," 42 U.S.C. 1903(l). (B) Not later than the first day of March annually, the medicaid director shall submit a report to the governor, the s…

Ohio Rev. Code Ann. § 5162.14 Legislative notice of action related to medicaid statement of expenditures form

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(A) The medicaid director shall immediately provide notice in accordance with this section if the United States centers for medicare and medicaid services does any of the following related to a quarterly medicaid statement of expenditures for medical assistance programs form that…

Ohio Rev. Code Ann. § 5162.15 Information required where annual medicaid payments exceed $5 million

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(A) As used in this section; "Agent" and "contractor" include any agent, contractor, subcontractor, or other person who, on behalf of an entity, furnishes or authorizes the furnishing of medicaid services, performs billing or coding functions, or is involved in monitoring of heal…

Ohio Rev. Code Ann. § 5162.16 Reporting fraud, waste, or abuse

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A government entity that administers one or more components of the medicaid program and has reasonable cause to believe that an instance of fraud, waste, or abuse has occurred in the medicaid program shall inform the department of medicaid. The department shall collect the inform…

Ohio Rev. Code Ann. § 5162.17 Electronic visit verification dashboard

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(A) As used in this section: (1) "Electronic visit verification" or "EVV" has the same meaning as in section 1903(l) of the "Social Security Act," 42 U.S.C. 1396b(l). (2) "Provider" means a medicaid provider required by state or federal law to utilize an electronic visit verifica…

Ohio Rev. Code Ann. § 5162.19 Evaluation for alternative primary insurance coverage

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(A) As used in this section, "alternative primary insurance coverage source" means an insurance coverage source that is not coverage under the medicaid program, including coverage under the medicare program or coverage under a health benefit plan as defined in section 3922.01 of …

Ohio Rev. Code Ann. § 5162.20 Cost-sharing requirements

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(A) The department of medicaid shall institute cost-sharing requirements for the medicaid program. The department shall not institute cost-sharing requirements in a manner that does either of the following: (1) Disproportionately impacts the ability of medicaid recipients with ch…

Ohio Rev. Code Ann. § 5162.21 Medicaid estate recovery program

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(A) As used in this section and section 5162.211 of the Revised Code: (1) "Estate" includes both of the following: (a) All real and personal property and other assets to be administered under Title XXI of the Revised Code and property that would be administered under that title i…

Ohio Rev. Code Ann. § 5162.211 Lien against property of recipient or spouse as part of estate recovery program

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(A) Except as provided in division (B) of this section and section 5162.23 of the Revised Code, no lien may be imposed against the property of an individual before the individual's death on account of medicaid services correctly paid or to be paid on the individual's behalf. (B) …

Ohio Rev. Code Ann. § 5162.212 Certification of amounts due under estate recovery program; collection

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The department of medicaid shall certify amounts due under the medicaid estate recovery program instituted under section 5162.21 of the Revised Code to the attorney general pursuant to section 131.02 of the Revised Code. The attorney general may enter into a contract with any per…

Ohio Rev. Code Ann. § 5162.22 Transfer of personal needs allowance account

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(A) As used in this section: (1) "Commissioner" means a person appointed by a probate court under division (E) of section 2113.03 of the Revised Code to act as a commissioner. (2) "Home" has the same meaning as in section 3721.10 of the Revised Code. (3) "Personal needs allowance…

Ohio Rev. Code Ann. § 5162.23 Recovering benefits incorrectly paid

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(A) The medicaid director shall adopt rules under section 5162.02 of the Revised Code permitting county departments of job and family services to take action to recover benefits incorrectly paid on behalf of medicaid recipients. The rules shall provide for recovery by the followi…

Ohio Rev. Code Ann. § 5162.24 Recovering health care costs provided to child

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(A) As used in this section, "third party" has the same meaning as in section 5160.35 of the Revised Code. (B) In addition to the authority granted under section 5160.38 of the Revised Code, the department of medicaid may, to the extent necessary to reimburse its costs, garnish t…

Ohio Rev. Code Ann. § 5162.25 State directed payment program requirements

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(A) As used in this section: (1) "State directed payment program" means a payment program authorized by the United States centers for medicare and medicaid services under 42 C.F.R. 438.6(c). (2) "Preprint" means a form created by the United States centers for medicare and medicai…

Ohio Rev. Code Ann. § 5162.251 State directed payment program reports

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The department of medicaid shall prepare and submit quarterly reports to the legislative service commission and the chairpersons of the standing committees in the house of representatives and the senate with jurisdiction over medicaid regarding any new state directed payment prog…

Ohio Rev. Code Ann. § 5162.30 Medicaid administrative claiming program

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(A) The medicaid director shall create a medicaid administrative claiming program under which federal financial participation is received for the administrative costs incurred by the department of health and the Arthur G. James cancer hospital and Richard J. Solove research insti…

Ohio Rev. Code Ann. § 5162.31 Local funds expended for administration of the healthy start component

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Local funds, whether from public or private sources, expended by a county department of job and family services for administration of the healthy start component shall be considered to have been expended by the state for the purpose of determining the extent to which the state ha…

Ohio Rev. Code Ann. § 5162.32 Contracts with political subdivisions to pay nonfederal share

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The department of medicaid may enter into contracts with political subdivisions to use funds of the political subdivision to pay the nonfederal share of expenditures under the medicaid program. The determination and provision of federal financial participation to a subdivision en…

Ohio Rev. Code Ann. § 5162.35 Contracts for administration of components

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The department of medicaid may enter into contracts with one or more other state agencies or political subdivisions to have the state agency or political subdivision administer one or more components of the medicaid program, or one or more aspects of a component, under the depart…

Ohio Rev. Code Ann. § 5162.36 Medicaid school component

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The medicaid director shall create, in accordance with sections 5162.36 to 5 162.366 of the Revised Code, the medicaid school component of the medicaid program.

Ohio Rev. Code Ann. § 5162.361 Claim by qualified medicaid school provider

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A qualified medicaid school provider participating in the medicaid school component of the medicaid program may submit a claim to the department of medicaid for federal financial participation for providing, in schools, services covered by the medicaid school component to medicai…

Ohio Rev. Code Ann. § 5162.362 Federal financial participation for medicaid school claims

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The department of medicaid shall seek federal financial participation for each claim a qualified medicaid school provider properly submits to the department under section 5162.361 of the Revised Code. The department shall disburse the federal financial participation the departmen…

Ohio Rev. Code Ann. § 5162.363 Administration of medicaid school component

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The department of medicaid shall enter into an interagency agreement with the department of education and workforce under section 5162.35 of the Revised Code that provides for the department of education and workforce to administer the medicaid school component of the medicaid pr…

Ohio Rev. Code Ann. § 5162.364 Adoption of rules for medicaid school component

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The medicaid director shall adopt rules under section 5162.02 of the Revised Code as necessary to implement the medicaid school component of the medicaid program, including rules that establish or specify all of the following: (A) Conditions a board of education of a city, local,…

Ohio Rev. Code Ann. § 5162.365 Responsibility for repaying overpayments

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(A) A qualified medicaid school provider is solely responsible for timely repaying any overpayment that the provider receives under the medicaid school component of the medicaid program and that is discovered by a federal or state audit. This is the case regardless of whether the…

Ohio Rev. Code Ann. § 5162.366 Referrals for certain services under the Medicaid School Program

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(A) Subject to division (B) of this section and for the purpose of a medicaid recipient receiving, in accordance with the recipient's individualized education program, physical therapy services, occupational therapy services, speech-language pathology services, or audiology servi…

Ohio Rev. Code Ann. § 5162.37 Contract approval required

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Any contract the department of medicaid enters into with the department 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) Tha…

Ohio Rev. Code Ann. § 5162.371 Contracts with department of mental health and addiction services; payment of nonfederal share of medicaid payment

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If the department of medicaid enters into a contract with the department of mental health and addiction services under section 5162.35 of the Revised Code, the department of medicaid shall pay the nonfederal share of any medicaid payment to a provider for services under the compo…

Ohio Rev. Code Ann. § 5162.40 Retaining or collecting percentage of federal financial participation

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(A) If a state agency or political subdivision administers one or more components of the medicaid program or administers one or more aspects of such a component, the department of medicaid may retain or collect not more than ten per cent of the federal financial participation the…

Ohio Rev. Code Ann. § 5162.41 Retaining or collecting percentage of supplemental payment

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The department of medicaid may retain or collect a percentage of the federal financial participation included in a supplemental medicaid payment to one or more medicaid providers owned or operated by a state agency or political subdivision that brings the payment to such provider…

Ohio Rev. Code Ann. § 5162.50 Health care-federal fund

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(A) The health care - federal fund is hereby created in the state treasury. All of the following shall be credited to the fund: (1) Funds that division (B) of section 5168.11 of the Revised Code requires be credited to the fund; (2) The federal share of all rebates paid by drug m…

Ohio Rev. Code Ann. § 5162.52 Health care/medicaid support and recoveries fund

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(A) The health care/medicaid support and recoveries fund is hereby created in the state treasury. All of the following shall be credited to the fund: (1) Except as otherwise provided by statute or as authorized by the controlling board, the nonfederal share of all medicaid-relate…

Ohio Rev. Code Ann. § 5162.56 Health care special activities fund

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There is created in the state treasury the health care special activities fund. The department of medicaid shall deposit all funds it receives pursuant to the administration of the medicaid program into the fund, other than any such funds that are required by law to be deposited …

Ohio Rev. Code Ann. § 5162.65 Refunds and reconciliation fund

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There is hereby created in the state treasury the refunds and reconciliation fund. Money the department of medicaid receives from a refund or reconciliation shall be deposited into the refunds and reconciliation fund if the department does not know the appropriate fund for the mo…

Ohio Rev. Code Ann. § 5162.66 Residents protection fund

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(A) There is hereby created in the state treasury the residents protection fund. All of the following shall be deposited into the fund: (1) The proceeds of all fines, including interest, collected under sections 5165.60 to 5165.89 of the Revised Code; (2) The proceeds of all fine…

Ohio Rev. Code Ann. § 5162.70 Reforms to medicaid program

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(A) As used in this section: (1) "CPI" means the consumer price index for all urban consumers as published by the United States bureau of labor statistics. (2) "CPI medical inflation rate" means the inflation rate for medical care, or the successor term for medical care, for the …

Ohio Rev. Code Ann. § 5162.71 Implementation of systems to improve health and reduce health disparities

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The medicaid director shall implement within the medicaid program systems that do both of the following: (A) Improve the health of medicaid recipients through the use of population health measures; (B) Reduce health disparities, including, but not limited to, those within racial …

Ohio Rev. Code Ann. § 5162.72 Strategies to address social determinants of health

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The medicaid director shall implement within the medicaid program strategies that address social determinants of health, including employment, housing, transportation, food, interpersonal safety, and toxic stress.

Ohio Rev. Code Ann. § 5162.73 Dental services for pregnant Medicaid recipients

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(A) The Department of Medicaid may establish and administer a program to provide dental services to pregnant Medicaid recipients. If the program is established, all of the following shall apply: (1) Medicaid recipients who are members of the group described in section 5163.06 of …

Ohio Rev. Code Ann. § 5162.75 Notification of veteran services

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The medicaid director shall provide, to a veteran who has submitted an application for the medicaid program, information about the county veterans service office that can assist with investigating and applying for benefits through the United States department of veterans affairs.…

Ohio Rev. Code Ann. § 5162.80 Good faith estimates for charges and payments

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(A) A provider of medical services licensed, accredited, or certified under Chapter 3721., 3727., 4715., 4725., 4731., 4732., 4734., 4747., 4753., 4755., 4757., or 4779. of the Revised Code shall provide in writing, before products, services, or procedures are provided, a reasona…

Ohio Rev. Code Ann. § 5162.82 Payment rate increase report

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Before making any payment rate increases greater than ten per cent under the medicaid program, the medicaid director shall notify the standing committees with oversight of the medicaid program as provided in section 103.41 of the Revised Code of the increase.