reglab/statecodes huggingface dataset:
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.04 | No State Cause of Action to Enforce Federal Laws.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 or employee to comply with that federal provision, shall be construed as creating a cause of action to enforce such state law beyond the causes of action available under federal law for enforcement of the provision of federal law.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.05 | Implementation of Medicaid Program.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 secretary, including amendments to waivers approved by the United States secretary;
(C) Other types of federal approval, including demonstration grants, that establish requirements for components of the medicaid program;
(D) Except as otherwise authorized by a federal medicaid waiver granted by the United States secretary, all applicable federal statutes, regulations, and policy guidances;
(E) All applicable state statutes.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.06 | Components Requiring Federal Approval or Funding.

Effective:
June 13, 2022
Latest Legislation:
House Bill 136 - 134th General Assembly
(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 approval, receipt of the federal approval;
(2) Sufficient federal financial participation for the component or aspect of the component;
(3) Sufficient nonfederal funds for the component or aspect of the component that qualify as funds needed to obtain the federal financial participation.
(B) A component, or aspect of a component, of the medicaid program that requires federal approval may begin to be implemented before receipt of the federal approval if federal law authorizes implementation to begin before receipt of the federal approval. Implementation shall cease if the federal approval is ultimately denied.
Last updated March 17, 2022 at 9:04 AM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.07 | Federal Approval for Permissive Components Not Required.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 than require be implemented. Federal approval shall be sought in the following forms as appropriate:
(A) The medicaid state plan;
(B) Amendments to the medicaid state plan;
(C) Federal medicaid waivers;
(D) Amendments to federal medicaid waivers;
(E) Other types of federal approval, including demonstration grants.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.10 | Review of Medicaid Program; Corrective Action; Sanctions.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 violated a rule governing the medicaid program, the director may establish a corrective action plan for the violator and impose fiscal, administrative, or both types of sanctions on the violator in accordance with rules adopted under section 5162.02 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.11 | Contract for Data Collection and Warehouse Functions Assessment.

Effective:
September 29, 2015
Latest Legislation:
House Bill 64 - 131st General Assembly
(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 warehouse functions of the medicaid data warehouse system, including the ability to link the data sets of all agencies serving medicaid recipients.
The assessment of the data system shall include functions related to fraud and abuse detection, program management and budgeting, and performance measurement capabilities of all agencies serving medicaid recipients, including the departments of aging, health, job and family services, medicaid, mental health and addiction services, and developmental disabilities.
A qualified vendor with whom the department of administrative services contracts to assess the data system shall also assist the medicaid agencies in the definition of the requirements for an enhanced data system or a new data system and assist the department of administrative services in the preparation of a request for proposals to enhance or develop a data system.
(B) Based on the assessment performed pursuant to division (A) of this section, the department of administrative services shall seek a qualified vendor through competitive selection pursuant to Chapter 125. of the Revised Code to develop or enhance a data collection and data warehouse system for the department of medicaid and all agencies serving medicaid recipients.
The department of medicaid shall seek enhanced federal financial participation for ninety per cent of the funds required to establish or enhance the data system. The department of administrative services shall not award a contract for establishing or enhancing the data system until the department of medicaid receives approval from the United States secretary of health and human services for the ninety per cent federal financial participation.
Last updated October 2, 2023 at 4:07 PM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.12 | Contracts for the Management of Medicaid Data Requests.

Effective:
October 17, 2019
Latest Legislation:
House Bill 166 - 133rd General Assembly
(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 made by persons who intend to use the items prepared pursuant to the requests for commercial or academic purposes.
(B) At a minimum, a contract entered into under this section shall do both of the following:
(1) Authorize the contracting person to engage in the activities described in division (A) of this section for compensation, which must be stated as a percentage of the fees paid by persons who are provided the items;
(2) Require the contracting person to charge for an item prepared pursuant to a request a fee in an amount equal to one hundred two per cent of the cost the department of medicaid incurs in making the data used to prepare the item available to the contracting person.
(C) Except as required by federal or state law and subject to division (E) of this section, both of the following conditions apply with respect to a request for data described in division (A) of this section:
(1) The request shall be made through a person who has entered into a contract with the medicaid director under this section.
(2) An item prepared pursuant to the request may be provided to the department of medicaid and is confidential and not subject to disclosure under section 149.43 or 1347.08 of the Revised Code.
(D) The medicaid director shall use fees the director receives pursuant to a contract entered into under this section to pay obligations specified in contracts entered under this section. Any money remaining after the obligations are paid shall be deposited in the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code.
(E) This section does not apply to 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 that are for any of the following purposes:
(1) Treatment of medicaid recipients;
(2) Payment of medicaid claims;
(3) Establishment or management of medicaid third party liability pursuant to sections 5160.35 to 5160.43 of the Revised Code;
(4) Compliance with the terms of an agreement the medicaid director enters into for purposes of administering the medicaid program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.132 | Annual Report Outlining Efforts to Minimize Fraud, Waste, and Abuse.

Effective:
March 20, 2014
Latest Legislation:
Senate Bill 206 - 130th General Assembly
Annually, the department of medicaid shall prepare a report on the department's efforts to minimize fraud, waste, and abuse in the medicaid program.
Each report shall be made available on the department's web site. The department shall submit a copy of each report to the governor, general assembly, and joint medicaid oversight committee. The copy to the general assembly shall be submitted in accordance with section 101.68 of the Revised Code. Copies of the report also shall be made available to the public on request.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.133 | Annual Program Report; Distribution; Contents.

Effective:
March 20, 2014
Latest Legislation:
Senate Bill 206 - 130th General Assembly
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, general assembly, and joint medicaid oversight committee. 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 following information:
(A) The number of individuals who participated in the medicaid buy-in for workers with disabilities program;
(B) The cost of the program;
(C) The amount of revenue generated by premiums that participants pay under section 5163.094 of the Revised Code;
(D) The average amount of earned income of participants' families;
(E) The average amount of time participants have participated in the program;
(F) The types of other health insurance participants have been able to obtain.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.134 | Annual Report of Integrated Care Delivery System Evaluation.

Effective:
March 20, 2014
Latest Legislation:
Senate Bill 206 - 130th General Assembly
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 and joint medicaid oversight committee. The copy to the general assembly shall be provided in accordance with section 101.68 of the Revised Code. The director also shall make the report available to the public.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.135 | Infant Mortality Scorecard.

Effective:
April 6, 2017
Latest Legislation:
Senate Bill 332 - 131st General Assembly
(A) As used in this section, "stillbirth" has the same meaning as in section 3701.97 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 care organization on population health measures, including the infant mortality rate, preterm birth rate, and low-birthweight rate, stillbirth rate, delineated in accordance with division (C) of this section;
(2) The performance of the fee-for-service component of medicaid and each medicaid managed care organization on service utilization and outcome measures using claims data and data from vital records;
(3) The number and percentage of women who are at least fifteen but less than forty-four years of age who are medicaid recipients;
(4) The number of medicaid recipients who delivered a newborn and the percentage of those who reported tobacco use at the time of delivery;
(5) The number of prenatal, postpartum, and adolescent wellness visits made by medicaid recipients;
(6) The percentage of pregnant medicaid recipients who initiated progesterone therapy during pregnancy;
(7) The percentage of female medicaid recipients of childbearing age who participate in a tobacco cessation program or use a tobacco cessation product;
(8) The percentage of female medicaid recipients of childbearing age who use long-acting reversible contraception;
(9) A comparison of the low-birthweight rate of medicaid recipients with the low-birthweight rate of women who are not medicaid recipients;
(10) Any other information on maternal and child health that the department considers appropriate.
(C) To the extent possible, the performance measures described in division (B)(1) of this section shall be delineated in the scorecard as follows:
(1) For each region of the state and the state as a whole, by race and ethnic group;
(2) For the urban and rural communities specified in rules adopted under section 3701.142 of the Revised Code, as well as for any other communities that are the subject of targeted infant mortality reduction initiatives administered by one or more state agencies, by race, ethnic group, and census tract.
The scorecard shall be updated each calendar quarter and made available on the department's internet web site.
(D) The department shall make available the data sources and methodology used to complete the scorecard to any person or government entity on request.
Last updated September 29, 2023 at 2:47 PM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.136 | Review of Barriers to Interventions Intended to Reduce Tobacco Use, Prevent Prematurity, and Promote Optimal Birth Spacing.

Effective:
April 6, 2017
Latest Legislation:
Senate Bill 332 - 131st General Assembly
(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 the effective date of this section. Thereafter, reviews shall be conducted every six months. The department shall prepare a report that summarizes the results of each review, which must contain the information specified in division (C)(1) or (2) of this section, as applicable. Each report shall be submitted to the commission on infant mortality, the joint medicaid oversight committee, and the general assembly. Submissions to the general assembly shall be made in accordance with section 101.68 of the Revised Code.
(B) The department shall make a presentation on each report at the first meeting of the commission on infant mortality that follows the report's submission to the commission.
(C)(1) All of the following shall be in the first report submitted in accordance with division (A) of this section:
(a) Identification of the access barriers described in division (A) of this section, the individuals affected by the barriers, and whether the barriers result from policies implemented by the department, medicaid managed care organizations, providers, or others;
(b) Recommendations for the expedient removal of the access barriers;
(c) An analysis of the performance of the fee-for-service component of medicaid and the performance of each medicaid managed care organization on health metrics pertaining to tobacco cessation, prematurity prevention, and birth spacing;
(d) Any other information the department considers pertinent to the report's topic.
(2) All of the following shall be in each subsequent report submitted in accordance with division (A) of this section:
(a) The progress that has been made on removing the access barriers described in division (A) of this section and the impact such progress has had on reducing the infant mortality rate in this state;
(b) A performance analysis of the fee-for-service component of medicaid and each medicaid managed care organization on health metrics pertaining to tobacco cessation, prematurity prevention, and birth spacing;
(c) Any other information the department considers pertinent.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.137 | Cost Savings Study.

Effective:
October 3, 2023
Latest Legislation:
House Bill 33 - 135th General Assembly
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
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.1310 | Evaluation of Success of Expansion Eligibility Group.

Effective:
October 17, 2019
Latest Legislation:
House Bill 166 - 133rd General Assembly
(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 conditions of their employment, including duration and hours of employment.
(B) For the purpose of aiding the department's evaluations under this section, medicaid managed care organizations shall collect and submit to the department relevant data about members of the expansion eligibility group who are enrolled in the organizations' medicaid MCO plans. The department may request that a medicaid managed care organization collect and submit to the department additional data the department needs for the evaluation.
(C) The department shall complete a report for each evaluation conducted under this section. The director shall provide a copy of the report to the general assembly and joint medicaid oversight committee. The copy to the general assembly shall be provided in accordance with section 101.68 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.16 | Reporting Fraud, Waste, or Abuse.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
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 information in the medicaid data warehouse system established under section 5162.11 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.20 | Cost-Sharing Requirements.

Effective:
September 18, 2020
Latest Legislation:
House Bill 11 - 133rd General Assembly
(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 chronic illnesses to obtain medically necessary medicaid services;
(2) Violates section 5164.09 or 5164.10 of the Revised Code.
(B)(1) No provider shall refuse to provide a service to a medicaid recipient who is unable to pay a required copayment for the service.
(2) Division (B)(1) of this section shall not be considered to do either of the following with regard to a medicaid recipient who is unable to pay a required copayment:
(a) Relieve the medicaid recipient from the obligation to pay a copayment;
(b) Prohibit the provider from attempting to collect an unpaid copayment.
(C) Except as provided in division (F) of this section, no provider shall waive a medicaid recipient's obligation to pay the provider a copayment.
(D) No provider or drug manufacturer, including the manufacturer's representative, employee, independent contractor, or agent, shall pay any copayment on behalf of a medicaid recipient.
(E) If it is the routine business practice of a provider to refuse service to any individual who owes an outstanding debt to the provider, the provider may consider an unpaid copayment imposed by the cost-sharing requirements as an outstanding debt and may refuse service to a medicaid recipient who owes the provider an outstanding debt. If the provider intends to refuse service to a medicaid recipient who owes the provider an outstanding debt, the provider shall notify the recipient of the provider's intent to refuse service.
(F) In the case of a provider that is a hospital, the cost-sharing program shall permit the hospital to take action to collect a copayment by providing, at the time services are rendered to a medicaid recipient, notice that a copayment may be owed. If the hospital provides the notice and chooses not to take any further action to pursue collection of the copayment, the prohibition against waiving copayments specified in division (C) of this section does not apply.
(G) The department of medicaid may collaborate with a state agency that is administering, pursuant to a contract entered into under section 5162.35 of the Revised Code, one or more components, or one or more aspects of a component, of the medicaid program as necessary for the state agency to apply the cost-sharing requirements to the components or aspects of a component that the state agency administers.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.212 | Certification of Amounts Due Under Estate Recovery Program; Collection.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 person or government entity to collect the amounts due on behalf of the attorney general.
The attorney general, in entering into a contract under this section, shall comply with all of the requirements that must be met for the state to receive federal financial participation for the costs incurred in entering into the contract and carrying out actions under the contract. The contract may provide for the person or government entity with which the attorney general contracts to be compensated from the property recovered under the medicaid estate recovery program or may provide for another manner of compensation agreed to by the parties to the contract.
Regardless of whether the attorney general collects the amounts due under the medicaid estate recovery program or contracts with a person or government entity to collect the amounts due on behalf of the attorney general, the amounts due shall be collected in accordance with applicable requirements of federal statutes and regulations and state statutes and rules.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.23 | Recovering Benefits Incorrectly Paid.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(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 following methods:
(1) Soliciting voluntary payments from recipients or from persons holding property in which a recipient has a legal or equitable interest;
(2) Obtaining a lien on property pursuant to division (B) of this section.
(B) A county department of job and family services may bring a civil action in a court of common pleas against a medicaid recipient for the recovery of any medicaid payments determined by the court to have been paid incorrectly on behalf of the recipient. All persons holding property in which the recipient has a legal or equitable interest may be joined as parties. The court may issue pre-judgment orders, including injunctive relief or attachment under Chapter 2715. of the Revised Code, for the preservation of real or personal property in which the recipient may have a legal or equitable interest. If the court determines that medicaid payments were made incorrectly and issues a judgment to that effect, the county department may obtain a lien upon property of the recipient in accordance with Chapter 2329. of the Revised Code.
(C) The county department of job and family services shall retain fifty per cent of the balance remaining after deduction from the recovery of the amount required to be returned to the federal government and shall pay the other fifty per cent of the balance to the department of medicaid.
(D) Recovery of medicaid payments incorrectly made on behalf of a medicaid recipient may not be accomplished by reducing the amount of benefits the recipient is entitled to receive under another government assistance program.
(E) The remedies provided pursuant to this section do not affect any other remedies county departments of job and family services may have to recover benefits incorrectly paid on behalf of medicaid recipients.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.24 | Recovering Health Care Costs Provided to Child.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(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 the wages, salary, or other employment income of, and withhold amounts from state tax refunds to, any person to whom both of the following apply:
(1) The person is required by a court or administrative order to provide coverage of the cost of health care services to a child eligible for medicaid.
(2) The person has received payment from a third party for the costs of such services but has not used the payment to reimburse either the other parent or guardian of the child or the provider of the services.
(C) Claims for current and past due child support shall take priority over claims under division (B) of this section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.30 | Medicaid Administrative Claiming Program.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(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 institute of the Ohio state university in analyzing and evaluating both of the following pursuant to sections 3701.261 and 3701.262 of the Revised Code:
(1) Cancer reports under the Ohio cancer incidence surveillance system;
(2) The incidence, prevalence, costs, and medical consequences of cancer on medicaid recipients and other low-income populations.
(B) The medicaid director shall consult with the director of health in creating the medicaid administrative claiming program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.31 | Local Funds Expended for Administration of the Healthy Start Component.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 has complied with any federal requirement that the state provide funds to match federal financial participation for the medicaid program. This section does not affect the amount of funds a county is entitled to receive under sections 5101.16 and 5101.161 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.32 | Contracts With Political Subdivisions to Pay Nonfederal Share.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 entering into a contract under this section shall be determined by the department, subject to section 5162.40 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.35 | Contracts for Administration of Components.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 department's supervision. A state agency or political subdivision that enters into such a contract shall comply with the terms of the contract and any rules the medicaid director has adopted governing the component, or aspect of the component, that the state agency or political subdivision is to administer, including any rules establishing review, audit, and corrective action plan requirements. A contract with a state agency shall be in the form of an interagency agreement.
A state agency or political subdivision that enters into a contract with the department under this section shall reimburse the department for the nonfederal share of the cost to the department of performing, or contracting for the performance of, a fiscal audit of the component of the medicaid program, or aspect of the component, that the state agency or political subdivision administers if rules governing the component, or aspect of the component, require that a fiscal audit be conducted.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.36 | Medicaid School Component.

Effective:
March 21, 2017
Latest Legislation:
House Bill 89 - 131st General Assembly
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.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.361 | Claim by Qualified Medicaid School Provider.

Effective:
March 21, 2017
Latest Legislation:
House Bill 89 - 131st General Assembly
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 medicaid recipients who are eligible for the services. No qualified medicaid school provider may submit such a claim before the provider incurs the cost of providing the service.
The claim shall include certification of the qualified medicaid school provider's expenditures for the service. The certification shall show that the money the qualified medicaid school provider used for the expenditures was nonfederal money the provider may legally use for providing the service and that the amount of the expenditures was sufficient to pay the full cost of the service.
Except as otherwise provided in sections 5162.36 to 5 162.366 of the Revised Code, a qualified medicaid school provider is subject to all conditions of participation in the medicaid program that generally apply to providers of goods and services under the medicaid program, including conditions regarding claims, audits, and recovery of overpayments.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.362 | Federal Financial Participation for Medicaid School Claims.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 department receives from the federal government for such a claim to the qualified medicaid school provider that submitted the claim. The department may not pay the qualified medicaid school provider the nonfederal share of the cost of the services for which the claim was submitted.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.363 | Administration of Medicaid School Component.

Effective:
October 3, 2023
Latest Legislation:
House Bill 33 - 135th General Assembly
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 program other than the aspects of the component that sections 5162.36 to 5162.366 of the Revised Code require the department of medicaid to administer. The interagency agreement may include a provision that provides for the department of education and workforce to pay to the department of medicaid the nonfederal share of a portion of the administrative expenses the department of medicaid incurs in administering the aspects of the component that the department of medicaid administers.
To the extent authorized by rules authorized by section 5162.021 of the Revised Code, the department of education and workforce shall adopt rules establishing a process by which qualified medicaid school providers participating in the medicaid school component pay to the department of education and workforce the nonfederal share of the department's expenses incurred in administering the component. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
Last updated September 21, 2023 at 9:15 AM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.364 | Adoption of Rules for Medicaid School Component.

Effective:
October 3, 2023
Latest Legislation:
House Bill 33 - 135th General Assembly
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, or exempted school district, a governing board of an educational service center, governing authority of a community school established under Chapter 3314. of the Revised Code,, and Ohio deaf and blind education services must meet to participate in the component;
(B) Services the component covers;
(C) Payment rates for the services the component covers.
The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
Last updated October 10, 2023 at 9:00 AM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.365 | Responsibility for Repaying Overpayments.

Effective:
October 3, 2023
Latest Legislation:
House Bill 33 - 135th General Assembly
(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 audit's finding identifies the provider, department of medicaid, or department of education and workforce as being responsible for the overpayment.
(B) The department of medicaid shall not do any of the following regarding an overpayment for which a qualified medicaid school provider is responsible for repaying:
(1) Make a payment to the federal government to meet or delay the provider's repayment obligation;
(2) Assume the provider's repayment obligation;
(3) Forgive the provider's repayment obligation.
(C) Each qualified medicaid school provider shall indemnify and hold harmless the department of medicaid for any cost or penalty resulting from a federal or state audit finding that a claim submitted by the provider under section 5162.361 of the Revised Code did not comply with a federal or state requirement applicable to the claim, including a requirement of a medicaid waiver component.
Last updated September 21, 2023 at 9:17 AM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.366 | Referrals for Certain Services Under the Medicaid School Program.

Effective:
March 21, 2017
Latest Legislation:
House Bill 89 - 131st General Assembly
(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 services under the medicaid school component of the medicaid program:
(1) A physical therapist is a licensed practitioner of the healing arts for the purpose of 42 C.F.R. 440.110(a)(1) and may make a referral for physical therapy services for the recipient.
(2) An occupational therapist is a licensed practitioner of the healing arts for the purpose of 42 C.F.R. 440.110(b)(1) and may make a referral for occupational therapy services for the recipient.
(3) A speech-language pathologist is a licensed practitioner of the healing arts for the purpose of 42 C.F.R. 440.110(c)(1) and may make a referral for speech-language pathology services for the recipient.
(4) An audiologist is a licensed practitioner of the healing arts for the purpose of 42 C.F.R. 440.110(c)(1) and may make a referral for audiology services for the recipient.
(B) To be able to make a referral for a service under this section, a physical therapist, occupational therapist, speech-language pathologist, or audiologist must have a provider agreement. This does not preclude a physical therapist, occupational therapist, speech-language pathologist, or audiologist from being an ordering or referring only provider.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.37 | Contract Approval Required.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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) That section 5162.371 of the Revised Code be complied with;
(B) How providers will be paid for providing the services;
(C) The responsibilities of the department of mental health and addiction services with regard to providers, including program oversight and quality assurance.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.371 | Contracts With Department of Mental Health and Addiction Services; Payment of Nonfederal Share of Medicaid Payment.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 component, or aspect of the component, the department of mental health and addiction services administers.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.40 | Retaining or Collecting Percentage of Federal Financial Participation.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
(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 state agency or political subdivision obtains through an approved, administrative claim regarding the component or aspect of the component. If the department retains or collects a percentage of such federal financial participation, the percentage the department retains or collects shall be specified in a contract the department enters into with the state agency or political subdivision under section 5162.35 of the Revised Code.
(B) All amounts the department retains or collects under this section shall be deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.41 | Retaining or Collecting Percentage of Supplemental Payment.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
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 or providers to the upper payment limit established by 42 C.F.R. 447.272. If the department retains or collects a percentage of that federal financial participation, the medicaid director shall adopt a rule under section 5162.02 of the Revised Code specifying the percentage the department is to retain or collect. All amounts the department retains or collects under this section shall be deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.50 | Health Care-Federal Fund.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(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 manufacturers to the department of medicaid in accordance with a rebate agreement required by the "Social Security Act," section 1927, 42 U.S.C. 1396r-8;
(3) The federal share of all supplemental rebates paid by drug manufacturers to the department of medicaid in accordance with the supplemental drug rebate program established under section 5164.755 of the Revised Code;
(4) Except as otherwise provided by statute or as authorized by the controlling board, the federal share of all other medicaid-related revenues, collections, and recoveries.
(B) All money credited to the health care - federal fund pursuant to division (B) of section 5168.11 of the Revised Code shall be used solely for distributing funds to hospitals under section 5168.09 of the Revised Code. The department of medicaid shall use all other money credited to the fund to pay for other medicaid services and contracts.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.52 | Health Care/medicaid Support and Recoveries Fund.

Effective:
October 17, 2019
Latest Legislation:
House Bill 166 - 133rd General Assembly
(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-related revenues, collections, and recoveries;
(2) Federal reimbursement received for payment adjustments made pursuant to section 1923 of the "Social Security Act," 42 U.S.C. 1396r-4, under the medicaid program to state mental health hospitals maintained and operated by the department of mental health and addiction services under division (A) of section 5119.14 of the Revised Code;
(3) Revenues the department of medicaid receives from another state agency for medicaid services pursuant to an interagency agreement;
(4) The money the department of medicaid receives in a fiscal year for performing eligibility verification services necessary for compliance with the independent, certified audit requirement of 42 C.F.R. 455.304;
(5) The nonfederal share of all rebates paid by drug manufacturers to the department of medicaid in accordance with a rebate agreement required by section 1927 of the "Social Security Act," 42 U.S.C. 1396r-8;
(6) The nonfederal share of all supplemental rebates paid by drug manufacturers to the department of medicaid in accordance with the supplemental drug rebate program established under section 5164.755 of the Revised Code;
(7) Amounts deposited into the fund pursuant to sections 5162.12, 5162.40, and 5162.41 of the Revised Code;
(8) The application fees charged to providers under section 5164.31 of the Revised Code;
(9) The fines collected under section 5165.1010 of the Revised Code;
(10) Amounts from assessments on hospitals under section 5168.06 of the Revised Code and intergovernmental transfers by governmental hospitals under section 5168.07 of the Revised Code that are deposited into the fund in accordance with the law.
(B) The department of medicaid shall use money credited to the health care/medicaid support and recoveries fund to pay for all of the following:
(1) Medicaid services;
(2) Costs associated with the administration of the medicaid program;
(3) Programs that serve youth involved with multiple government agencies;
(4) Innovative programs that the department has statutory authority to implement and that promote access to health care or help achieve long-term cost savings to the state.