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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

1,983 sections·Filtered byTitle 51✕

Ohio Rev. Code Ann. § 5167.173 Community health worker services or services provided by public health nurse
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(A) As used in this section: (1) "Board of health" means the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code. (2) "Certified community health worker" has the same meaning as in …
Ohio Rev. Code Ann. § 5167.18 Identification of fraud, waste, and abuse
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Each medicaid managed care organization shall comply with federal and state efforts to identify fraud, waste, and abuse in the medicaid program.
Ohio Rev. Code Ann. § 5167.20 Reference by managed care organization to noncontracting participant
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(A) Except as provided in division (B) of this section, when a medicaid managed care organization refers an enrollee to receive services, other than emergency services provided on or after January 1, 2007, at a hospital that participates in the medicaid program but is not under c…
Ohio Rev. Code Ann. § 5167.201 Payment of nonsystem provider for emergency services
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When a medicaid managed care organization's enrollee receives emergency services on or after January 1, 2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the amounts (less any…

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Ohio Rev. Code Ann. § 5167.21 Payments to skilled nursing facility

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(A) As used in this section: (1) "Covered skilled nursing facility services" has the same meaning as in the "Social Security Act," section 1888(e)(2)(A), 42 U.S.C. 1395yy(e)(2)(A).(2) "Current medicare fee-for-service rate" means the fee-for-service rate in effect for a covered s…

Ohio Rev. Code Ann. § 5167.22 Recoupment of overpayment

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When a medicaid managed care organization seeks to recoup an overpayment made to a provider, it shall provide the provider all of the details of the recoupment, including all of the following information: (A) The name, address, and medicaid identification number of the enrollee t…

Ohio Rev. Code Ann. § 5167.221 Assessment of recoupment efforts

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The department of medicaid shall assess the efforts of medicaid managed care organizations to recoup overpayments made to providers who are network providers and providers who are not network providers. The assessments shall examine the amount of time recoupment efforts take star…

Ohio Rev. Code Ann. § 5167.24 Third-party administrator as single pharmacy benefit manager

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(A) If the department of medicaid includes prescribed drugs in the care management system as authorized under section 5167.05 of the Revised Code, the medicaid director, through a procurement process, shall select a third-party administrator to serve as the single pharmacy benefi…

Ohio Rev. Code Ann. § 5167.241 State pharmacy benefit manager contract; payment arrangements

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Medicaid managed care organizations shall use the state pharmacy benefit manager selected under section 5167.24 of the Revised Code pursuant to the terms of the master contract entered into under that section. All payment arrangements between the department of medicaid, medicaid …

Ohio Rev. Code Ann. § 5167.243 Quarterly reports

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(A) The state pharmacy benefit manager shall provide to the medicaid director a written quarterly report containing the following information from the immediately preceding quarter: (1) The prices that the state pharmacy benefit manager negotiated for prescribed drugs under the c…

Ohio Rev. Code Ann. § 5167.244 Violations; penalty

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No person shall violate the terms of the master state pharmacy benefit manager contract under section 5167.24 of the Revised Code or section 5167.241 of the Revised Code. Whoever violates those sections is subject to a civil penalty in an amount to be determined by the medicaid d…

Ohio Rev. Code Ann. § 5167.245 Appeals process

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The medicaid director shall establish an appeals process by which pharmacies may appeal to the department of medicaid any disputes relating to the maximum allowable cost set by the state pharmacy benefit manager for a prescribed drug. All pharmacies participating in the care mana…

Ohio Rev. Code Ann. § 5167.26 Records for determining costs

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For the purpose of determining the amount the department of medicaid pays hospitals under section 5168.09 of the Revised Code and the amount of disproportionate share hospital payments paid by the medicare program pursuant to section 1915 of the "Social Security Act," 42 U.S.C. 1…

Ohio Rev. Code Ann. § 5167.30 Managed care performance payment program

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(A)(1) The department of medicaid shall establish a managed care performance payment program. Under the program, the department may provide payments to medicaid managed care organizations that meet performance standards established by the department.(2) In establishing performanc…

Ohio Rev. Code Ann. § 5167.31 Financial incentive awards

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The department of medicaid may provide financial incentive awards to medicaid managed care organizations that meet or exceed performance standards specified in provider agreements or rules adopted by the medicaid director under section 5167.02 of the Revised Code. The department …

Ohio Rev. Code Ann. § 5167.32 Improving integrity of care management system

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Not later than July 1, 2016, the department of medicaid shall implement strategies to improve the integrity of the care management system, including strategies to do both of the following:(A) Increase the department's oversight of medicaid managed care organizations;(B) Provide i…

Ohio Rev. Code Ann. § 5167.33 Strategies regarding payment to providers

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(A) Not later than July 1, 2018, each medicaid managed care organization shall implement strategies that base payments to providers on the value received from the providers' services, including their success in reducing waste in the provision of the services. Not later than July …

Ohio Rev. Code Ann. § 5167.34 Immunity from liability

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A medicaid managed care organization, its officers, employees, or other persons associated with the managed care organization are not liable in a civil action for damages or other relief for furnishing information to the department of medicaid regarding potential fraud, waste, or…

Ohio Rev. Code Ann. § 5167.35 Meaningful employment of Medicaid recipients

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(A) Consistent with the requirements of the care management system implemented on February 1, 2023, to address medicaid population health and social determinants of health and encourage optimal health and self-sufficiency of medicaid enrollees, the department of medicaid, in coll…

Ohio Rev. Code Ann. § 5167.40 Appointment of temporary manager

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The department of medicaid shall appoint a temporary manager for a medicaid managed care organization if the department determines that the medicaid managed care organization has repeatedly failed to meet substantive requirements specified in the "Social Security Act," sections 1…

Ohio Rev. Code Ann. § 5167.41 Disenrolling some or all medicaid recipients from MCO plan offered by a managed care organization

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The department of medicaid may disenroll some or all medicaid recipients from a medicaid MCO plan offered by a medicaid managed care organization if the department proposes to terminate or not to renew the contract entered into under section 5167.10 of the Revised Code and determ…

Ohio Rev. Code Ann. § 5167.45 Information about medicaid recipients' races, ethnicities, and primary languages

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The department of medicaid shall include information about medicaid recipients' races, ethnicities, and primary languages in data the department shares with medicaid managed care organizations. Medicaid managed care organizations shall include this information in the data the org…

Ohio Rev. Code Ann. § 5167.47 Compliance with federal mental health and addiction parity laws

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(A) When contracting with a medicaid managed care organization, the department of medicaid shall require the medicaid managed care organization to provide to medicaid enrollees the same benefits and rights as required under division (B) of section 3902.36 of the Revised Code. (B)…

Ohio Rev. Code Ann. § 5168.01 Hospital care assurance program definitions

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As used in sections 5168.01 to 5168.14 of the Revised Code:(A) "Bad debt," "charity care," "courtesy care," and "contractual allowances" have the same meanings given these terms in regulations adopted under Title XVIII of the "Social Security Act," 42 U.S.C. 1395 et seq.(B) "Cost…

Ohio Rev. Code Ann. § 5168.02 Adoption of rules

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(A) The medicaid director shall adopt rules in accordance with Chapter 119. of the Revised Code for the purpose of administering sections 5168.01 to 5168.14 of the Revised Code, including rules that do all of the following: (1) Define as a "disproportionate share hospital" any ho…

Ohio Rev. Code Ann. § 5168.03 Provisions dependent on assessment as permissible health care-related tax

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The requirements of sections 5168.06 to 5168.09 of the Revised Code apply only as long as the United States centers for medicare and medicaid services determines that the assessment imposed under section 5168.06 of the Revised Code is a permissible health care-related tax pursuan…

Ohio Rev. Code Ann. § 5168.04 Program year basis of operation

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The department of medicaid shall operate the hospital care assurance program established by sections 5168.01 to 5168.14 of the Revised Code on a program year basis. The department shall complete all program requirements on or before the thirtieth day of September each year. Last …

Ohio Rev. Code Ann. § 5168.05 Submitting financial statement and cost report

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(A) Except as provided in division (C) of this section, each hospital, on or before the first day of July of each year or at a later date approved by the medicaid director, shall submit to the department of medicaid a financial statement for the preceding calendar year that accur…

Ohio Rev. Code Ann. § 5168.06 Annual assessment

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(A) For the purpose of distributing funds to hospitals under the medicaid program pursuant to sections 5168.01 to 5168.14 of the Revised Code and depositing funds into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code, there is…

Ohio Rev. Code Ann. § 5168.07 Requiring governmental hospitals to make intergovernmental transfers

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(A) The department of medicaid may require governmental hospitals to make intergovernmental transfers each program year for the purpose of distributing funds to hospitals under the medicaid program pursuant to sections 5168.01 to 5168.14 of the Revised Code and depositing funds i…

Ohio Rev. Code Ann. § 5168.08 Preliminary determination of assessment

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(A) Before or during each program year, the department of medicaid shall issue to each hospital the preliminary determination of the amount that the hospital is assessed under section 5168.06 of the Revised Code during the program year. The preliminary determination of a hospital…

Ohio Rev. Code Ann. § 5168.09 Methodology to pay hospitals sufficient to expend all money in indigent care pool

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The medicaid director shall adopt rules under section 5168.02 of the Revised Code establishing a methodology to pay hospitals that is sufficient to expend all money in the indigent care pool. Under the rules:(A) The department of medicaid may classify similar hospitals into group…

Ohio Rev. Code Ann. § 5168.10 Prohibiting replacing funds appropriated for medicaid program

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Except for moneys deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code, the department of medicaid shall not use money paid to the department under sections 5168.06 and 5168.07 of the Revised Code or money that the …

Ohio Rev. Code Ann. § 5168.11 Hospital care assurance program fund

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(A) Except as provided in section 5162.52 of the Revised Code, all payments of assessments by hospitals under section 5168.06 of the Revised Code and all intergovernmental transfers under section 5168.07 of the Revised Code shall be deposited in the state treasury to the credit o…

Ohio Rev. Code Ann. § 5168.13 Confidentiality

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Except as specifically required by sections 5168.01 to 5168.14 of the Revised Code, information filed under those sections shall not include any patient-identifying material. Information that includes patient-identifying material is not a public record under section 149.43 of the…

Ohio Rev. Code Ann. § 5168.14 Providing basic, medically necessary hospital-level services to individuals who are residents

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(A) Each hospital that receives funds distributed under sections 5168.01 to 5168.14 of the Revised Code shall provide, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of this state, are not medicaid recipients,…

Ohio Rev. Code Ann. § 5168.20 Definitions for R.C. 5168.20 to 5168.28

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As used in sections 5168.20 to 5168.28 of the Revised Code:(A) "Applicable assessment percentage" means the percentage specified in rules adopted under section 5168.26 of the Revised Code that is used in calculating a hospital's assessment under section 5168.21 of the Revised Cod…

Ohio Rev. Code Ann. § 5168.21 Additional annual assessment

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(A) For the purposes specified in section 5168.25 of the Revised Code and subject to section 5168.28 of the Revised Code, there is hereby imposed an assessment on all hospitals each assessment program year. The amount of a hospital's assessment for an assessment program year shal…

Ohio Rev. Code Ann. § 5168.22 Preliminary determination of assessment amount

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(A) Before or during each assessment program year, the department of medicaid shall issue to each hospital the preliminary determination of the amount that the hospital is assessed under section 5168.21 of the Revised Code for the assessment program year. Except as provided in di…

Ohio Rev. Code Ann. § 5168.23 Assessment payment schedule

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Each hospital shall pay the amount it is assessed under section 5168.21 of the Revised Code in accordance with a payment schedule the department of medicaid shall establish for each assessment program year. The department shall consult with the Ohio hospital association before es…

Ohio Rev. Code Ann. § 5168.24 Audit

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The department of medicaid may audit a hospital to ensure that the hospital properly pays the amount it is assessed under section 5168.21 of the Revised Code. The department shall take action to recover from a hospital any amount the audit reveals that the hospital should have pa…

Ohio Rev. Code Ann. § 5168.25 Hospital assessment fund

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There is hereby created in the state treasury the hospital assessment fund. All installment payments made by hospitals under section 5168.23 of the Revised Code and all recoveries the department of medicaid makes under section 5168.24 of the Revised Code shall be deposited into t…

Ohio Rev. Code Ann. § 5168.26 Excluded costs

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(A) The medicaid director shall adopt rules in accordance with Chapter 119. of the Revised Code as necessary to implement sections 5168.20 to 5168.28 of the Revised Code, including rules that specify the percentage of hospitals' total facility costs to be used in calculating hosp…

Ohio Rev. Code Ann. § 5168.27 Implementation shall not cause reduction in federal participation for medicaid program

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The medicaid director shall implement the assessment imposed by section 5168.21 of the Revised Code in a manner that does not cause a reduction in federal financial participation for the medicaid program under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w). Last u…

Ohio Rev. Code Ann. § 5168.28 Determination of assessment as impermissible health care-related tax

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If the United States secretary of health and human services determines that the assessment imposed by section 5168.21 of the Revised Code is an impermissible health care-related tax under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w), the medicaid director shall …

Ohio Rev. Code Ann. § 5168.40 Franchise permit fee definitions

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As used in sections 5168.40 to 5168.56 of the Revised Code: (A) "Bed surrender" means the following: (1) In the case of a nursing home, the removal of a bed from a nursing home's licensed capacity in a manner that reduces the total licensed capacity of all nursing homes and makes…

Ohio Rev. Code Ann. § 5168.41 Determination of nursing home and hospital long-term care franchise permit fee rate

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(A) The franchise permit fee rate shall be determined for each fiscal year as follows: (1) Determine the estimated total net patient revenues for all nursing homes and hospital long-term care units for the fiscal year;(2) Multiply the estimated total net patient revenues determin…

Ohio Rev. Code Ann. § 5168.42 Annual franchise permit fee

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The department of medicaid shall do all of the following: (A) Subject to sections 5168.44, 5168.45, and 5168.48 of the Revised Code and divisions (C) and (D) of this section and for the purposes specified in section 5168.54 of the Revised Code, determine an annual franchise permi…

Ohio Rev. Code Ann. § 5168.43 Waiver of franchise permit fee

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(A) Not later than four months after July 17, 2009, the department of medicaid shall apply to the United States secretary of health and human services for a waiver under the "Social Security Act," section 1903(w)(3)(E), 42 U.S.C. 1396b(w)(3)(E), as necessary to do both of the fol…

Ohio Rev. Code Ann. § 5168.44 Approval of waiver; Reduction in franchise permit fee rate

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If the United States secretary of health and human services approves the waiver sought under section 5168.43 of the Revised Code, the department of medicaid shall, for each nursing home and hospital that qualifies for a reduction of its franchise permit fee rate under the waiver,…