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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. § 5164.13 Prior authorization for personal care services
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(A) As used in this section: (1) "Independent provider" has the same meaning as in section 5164.341 of the Revised Code. (2) "Personal care services" means any service reimbursed under the medicaid program that assists a recipient who is not an inpatient in a hospital or a reside…
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. § 5164.292 Medicaid provider credentialing

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(A) The department of medicaid shall require the providers and facilities described in this section to provide the department or the department's credentialing designee with the information described in divisions (B) and (C) of this section every twenty-four months, or sooner if …

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 sec…

Ohio Rev. Code Ann. § 5164.302 Provider in-person review or site visit

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(A) Before entering into a provider agreement with a medicaid provider that seeks initial enrollment as a provider of home and community-based services under the medicaid program, the department of medicaid shall conduct an in-person review of the individual or site inspection of…

Ohio Rev. Code Ann. § 5164.303 Medicaid fraud disclaimer

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(A) The department of medicaid shall coordinate with the attorney general to create a disclaimer form that provides an affirmative and explicit explanation of the penalties specified in section 2913.40 of the Revised Code for medicaid fraud. (B) The department shall provide a cop…

Ohio Rev. Code Ann. § 5164.304 Medicaid provider onboarding

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The department of medicaid shall establish a standardized onboarding process for all providers with a valid provider agreement with the department. The onboarding process shall provide a link to the relevant administrative rules that describe the provider agreement requirements f…

Ohio Rev. Code Ann. § 5164.305 Ownership disclosure

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(A) As a condition of entering into a provider agreement with the department of medicaid or revalidating an existing provider agreement, each person or government entity seeking to enroll in the medicaid program as a provider or to revalidate an existing provider agreement shall …

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 three years from its effective date or sooner if determined necessary by the medicaid director. (B) The medicaid director shall adopt rules under section 5164.02 of the Revised Code as necessary to implement this se…

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

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(A)(1) 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: (a) Deny, refuse to revalidate, suspend, or terminate a provider ag…

Ohio Rev. Code Ann. § 5164.331 Shared address and phone number of Medicaid providers

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The department of medicaid shall conduct an investigation if the department determines that an individual or entity seeking initial enrollment as a provider shares the same address or telephone number as a current provider. If an investigation conducted by the department determin…

Ohio Rev. Code Ann. § 5164.332 Provider suspension for suspicious increase in claims

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(A) The department of medicaid shall impose a temporary suspension of medicaid payments and conduct an investigation if the department determines there is a suspicious increase in the number of claims for payment submitted by a provider in the first sixty days of the provider ent…

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. A "credible allega…

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. § 5164.40 Definitions

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As used in sections 5164.40 to 5164.406 of the Revised Code: (A) "Electronic verification system" means an electronic system capable of recording and verifying data elements related to the delivery of health care services covered by the medicaid program. (B) "GPS-based verificati…

Ohio Rev. Code Ann. § 5164.401 Verification of nonemergency medical transportation services

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(A) The department of medicaid shall develop, procure, certify, or approve a process or system to obtain global positioning system coordinates to verify nonemergency medical transportation services provided under the medicaid program to medicaid recipients. In developing, procuri…

Ohio Rev. Code Ann. § 5164.402 Use of electronic verification system by nonemergency medical transportation service providers; exemptions

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(A) Upon full implementation of the electronic verification systems developed, procured, certified, or approved in accordance with section 5164.401 of the Revised Code, no nonemergency medical transportation service provider shall be eligible to receive medicaid payment for trans…

Ohio Rev. Code Ann. § 5164.403 System to cross-reference claims

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(A) Not later than five years after the effective date of this section, the department of medicaid shall develop and implement a system by which global positioning system coordinates data received from a nonemergency medical transportation service provider may be cross-referenced…

Ohio Rev. Code Ann. § 5164.404 Automated fraud-detection tools

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(A) The department of medicaid shall develop and implement automated fraud-detection tools to assist with identifying fraud through the use of the electronic verification systems developed, procured, certified, or approved under section 5164.401 of the Revised Code. Any fraud-det…

Ohio Rev. Code Ann. § 5164.405 Electronic verification annual report

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Annually, the department of medicaid shall submit a report to the general assembly detailing electronic verification systems developed, procured, certified, or approved under section 5164.401 of the Revised Code. The report shall be submitted to the general assembly in accordance…

Ohio Rev. Code Ann. § 5164.406 Rulemaking

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The department of medicaid shall adopt rules in accordance with Chapter 119. of the Revised Code to implement sections 5164.40 to 5164.406 of the Revised Code. The rules shall address all of the following: (A) Technical standards for electronic verification systems developed, pro…

Ohio Rev. Code Ann. § 5164.41 Family caregiver oversight

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(A) As used in this section, "home and community-based services medicaid waiver component" has the same meaning as in section 5166.01 of the Revised Code. (B) The department of medicaid shall establish oversight mechanisms concerning services provided by a family caregiver under …

Ohio Rev. Code Ann. § 5164.42 Electronic visit verification requirements

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(A) As used in this section and section 5164.421 of the Revised Code: (1) "Electronic visit verification" has the same meaning as in section 1903(l) of the "Social Security Act," 42 U.S.C. 1396b(l). (2) "GPS-based verification" means real-time satellite location data that can be …

Ohio Rev. Code Ann. § 5164.421 Electronic visit verification for high-risk providers

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(A) In addition to the electronic visit verification system described in section 5165.42 of the Revised Code, the department of medicaid shall establish requirements under which high risk in-home care service providers are required to verify data regarding the services provided t…

Ohio Rev. Code Ann. § 5164.43 Employee protections for reporting Medicaid fraud

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(A) As used in this section: (1) "Employee" means any person who performs a service for wages or other remuneration for an employer. (2) "Employer" means any person who has one or more employees and includes an agent of an employer, the state or any agency or instrumentality of t…

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 sub…

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) and division (E) 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 overpa…