Ohio · statute · Ohio Rev. Code ch. 5162 · 67 active provisions
(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 medicaid waiver granted by the United States s…
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 components, the other state agencies administe…
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 Revised Code. No state agency or politica…
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. 431.10(e) and all other federal require…
(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. 108-173: (1) Adopt rules in accordance with…
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 state, a state agency, or any state official…
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 waivers granted by the United States secretar…
(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 of the component, requires federal appr…
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 components, that state statutes permit rather…
(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 Security Act," 42 U.S.C. 1315 and 42 U.S.C.…
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 that a person or government entity has v…
(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 assessment of the data collection and data wareho…
(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 or analyses of any of the foregoing data…
(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 following, delineated by race and ethnic group…
(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 concluded state fiscal year: (1) Improper medic…
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 Code. The report shall include all of the…
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 in accordance with section 101.68 of the…
(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 component of medicaid and each medicaid managed…
(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 later than sixty days after April 6, 2017…
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. Last updated October 6, 2023 at 4:53 PM
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 program. Last updated August 12, 2026 at 4…
(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 speaker of the house of representatives,…
(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 stable employment; (3) Improving the conditi…
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 expenditures for a particular service f…