reglab/statecodes huggingface dataset:
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.22 | Examination of Records Regarding Medical Assistance Programs.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The auditor of state and attorney general, or their designees, may examine any records, whether in computer or printed format, in the possession of the medicaid director or any county director of job and family services, regarding medical assistance programs. The auditor of state and attorney general shall do both of the following regarding the records:
(1) Provide safeguards that restrict access to the records to purposes directly connected with an audit or investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of the programs;
(2) Comply, and ensure that their designees comply, with section 5160.45 of the Revised Code and rules of the medicaid director restricting the disclosure of information regarding medical assistance recipients.
(B) Any person who fails to comply with the restriction specified in division (A) of this section is disqualified from acting as an agent or employee or in any other capacity under appointment or employment of any state board, commission, or agency.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.23 | Audit Costs.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The auditor of state is responsible for the costs the auditor incurs in carrying out the auditor's duties under sections 5160.21 and 5160.22 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.29 | Verification of Eligibility for Medical Assistance Program.

Effective:
July 1, 2019
Latest Legislation:
House Bill 119 - 132nd General Assembly
(A) As part of the process of determining an individual's eligibility for a medical assistance program, at least all of the following information about the individual shall be verified:
(1) Identity;
(2) Citizenship and alien eligibility;
(3) Social security number;
(4) State residency status;
(5) Disability status;
(6) Gross nonexempt income;
(7) Household status ;
(8) Medical expenses;
(9) Enrollment status in other state-administered public assistance programs within and outside the state.
( B) As part of the process of determining an individual's eligibility for a medical assistance program, each applicant, or a person acting on the applicant's behalf, shall verify the applicant's identity.
(C)(1) The department of medicaid shall sign a memorandum of understanding with any department, agency, or division as needed to obtain the information specified in division (A) of this section.
(2) The department may contract with one or more independent vendors to provide the information identified in division (A) of this section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.291 | Changes Affecting Eligibility.

Effective:
July 1, 2019
Latest Legislation:
House Bill 119 - 132nd General Assembly
(A)(1) As information described in division (A) of section 5160.29 of the Revised Code is received by the department of medicaid or an entity with which the department has entered into an agreement under section 5160.30 of the Revised Code, the department or entity shall do both of the following on at least a quarterly basis and in accordance with federal regulations:
(a) Review the information to determine whether it indicates a change in circumstances that may affect eligibility for a medical assistance program;
(b) Take appropriate action.
( 2) Division (A)(1) of this section applies only to the extent information described in division (A) of section 5160.29 of the Revised Code is available to the department or entity.
(B) If the department of medicaid or an entity with which the department has entered into an agreement under section 5160.30 of the Revised Code receives information concerning a medical assistance recipient that indicates a change in circumstances that may affect the recipient's continued eligibility for the medical assistance program in which the recipient is enrolled, the department or entity shall take appropriate action, including verifying unclear information, providing prior written notice of a change or adverse action, and notifying the recipient of the right to appeal under section 5160.31 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.292 | Medicaid Eligibility Fraud.

Effective:
July 1, 2019
Latest Legislation:
House Bill 119 - 132nd General Assembly
If a violation of section 2913.401 of the Revised Code or a similar offense is suspected in the process of determining or redetermining a medical assistance recipient's eligibility, the case shall be referred for investigation to the county prosecutor of the county in which the medical assistance recipient resides, referred for an administrative disqualification hearing, or both.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.293 | Construction.

Effective:
July 1, 2019
Latest Legislation:
House Bill 119 - 132nd General Assembly
Nothing in sections 5160.29 to 5160.292 of the Revised Code prevents the department of medicaid or any entity with which the department has entered into an agreement under section 5160.30 of the Revised Code from doing either of the following:
(A) Receiving or reviewing information related to individuals' eligibility for a medical assistance program beyond the information specified in division (A) of section 5160.29 of the Revised Code;
(B) Contracting with one or more independent vendors to provide such additional information for such purpose.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.30 | Administrative Activities for Medical Assistance Programs.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) Except as provided in divisions (B) and (C) of this section, the department of medicaid may accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities for medical assistance programs.
(B) The department may enter into agreements with one or more agencies of the federal government, the state, other states, and local governments of this or other states to accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities on behalf of the department with respect to medical assistance programs.
(C) If federal law requires a face-to-face interview to complete an eligibility determination for a medical assistance program, the department shall not conduct the face-to-face interview.
(D) Subject to division (C) of this section, if the department elects to accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities for a medical assistance program, both of the following apply:
(1) An individual may apply for the medical assistance program to the department or an agency authorized by an agreement entered into under division (B) of this section to accept the individual's application;
(2) The department is subject to federal statutes and regulations and state statutes and rules that require, permit, or prohibit an action regarding accepting applications, determining or redetermining eligibility, and performing related administrative activities for the medical assistance program.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.31 | Appeals Regarding Determination of Eligibility for Medical Assistance Program.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) A medical assistance recipient may appeal a decision regarding the recipient's eligibility for a medical assistance program or services available to the recipient under a medical assistance program.
(B) Regarding appeals authorized by this section, the department of medicaid shall do one or more of the following:
(1) Administer an appeals process similar to the appeals process established under section 5101.35 of the Revised Code;
(2) Contract with the department of job and family services pursuant to section 5162.35 of the Revised Code to provide for the department of job and family services to hear the appeals in accordance with section 5101.35 of the Revised Code;
(3) Delegate authority to hear appeals to an exchange or exchange appeals entity.
(C) If a medical assistance recipient files an appeal as authorized by this section, the department of medicaid may do either or both of the following:
(1) Take corrective action regarding the matter being appealed before a hearing decision regarding the matter is issued;
(2) If a hearing decision, administrative appeal decision, or court ruling is against the recipient, take action in favor of the recipient despite the contrary decision or ruling, unless, in the case of a court's ruling, the ruling prohibits the department from taking the action.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.35 | Recovery of Medical Support Definitions.

Effective:
October 3, 2023
Latest Legislation:
House Bill 33 - 135th General Assembly
As used in sections 5160.35 to 5160.43 of the Revised Code:
(A) "Information" means all of the following:
(1) An individual's name, address, date of birth, and social security number;
(2) The group or plan number, or other identifier, assigned by a third party to a policy held by an individual or a plan in which the individual participates and the nature of the coverage;
(3) Any other data the medicaid director specifies in rules authorized by section 5160.43 of the Revised Code.
(B) "Medical support" means support specified as support for the purpose of medical care by order of a court or administrative agency.
(C)(1) Subject to division (C)(2) of this section, and except as provided in division (C)(3) of this section, "third party" means all of the following:
(a) A person authorized to engage in the business of sickness and accident insurance under Title XXXIX of the Revised Code;
(b) A person or governmental entity providing coverage for medical services or items to individuals on a self-insurance basis;
(c) A health insuring corporation as defined in section 1751.01 of the Revised Code;
(d) A group health plan as defined in 29 U.S.C. 1167;
(e) A service benefit plan as referenced in 42 U.S.C. 1396a(a)(25);
(f) A managed care organization;
(g) A pharmacy benefit manager;
(h) A third party administrator;
(i) Any other person or governmental entity that is, by law, contract, or agreement, responsible for the payment or processing of a claim for a medical item or service for a medical assistance recipient.
(2) Except when otherwise provided by the "Social Security Act," section 1862(b), 42 U.S.C. 1395y(b), a person or governmental entity listed in division (C)(1) of this section is a third party even if the person or governmental entity limits or excludes payments for a medical item or service in the case of a public assistance recipient.
(3) "Third party" does not include the program for children and youth with special health care needs established under section 3701.023 of the Revised Code.
Last updated October 6, 2023 at 11:53 AM
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.371 | Disclosure of Third-Party Payer Information.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
In addition to the requirement of division (C) of section 5160.37 of the Revised Code to cooperate with the department of medicaid and county department of job and family services, a medical assistance recipient and the recipient's attorney, if any, shall cooperate with each medical provider of the recipient. Cooperation with a medical provider shall consist of disclosing to the provider all information the recipient and attorney, if any, possess that would assist the provider in determining each third party that is responsible for the payment or processing of a claim for medical assistance provided to the recipient. If disclosure is not made in accordance with this section, the recipient and the recipient's attorney, if any, are liable to reimburse the department or county department for the amount that would have been paid by a third party had the third party been disclosed to the provider by the recipient or the recipient's attorney.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.38 | Assignment of Rights to Department.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The application for, or enrollment in, a medical assistance program constitutes an automatic assignment of rights specified in division (B) of this section to the department of medicaid. This assignment includes the rights of the medical assistance recipient and also the rights of any other member of the assistance group for whom the recipient can legally make an assignment.
(B) Pursuant to this section, a medical assistance recipient assigns to the department any rights to medical support available to the recipient or other members of the recipient's assistance group under an order of a court or administrative agency, and any rights to payments by a liable third party for the cost of medical assistance paid on behalf of the recipient or other members of the assistance group. The recipient shall cooperate with the department in obtaining such payments.
Medicare benefits shall not be assigned pursuant to this section. Benefits assigned to the department by operation of this section are directly reimbursable to the department by liable third parties.
(C) Refusal by a medical assistance recipient to cooperate in obtaining medical assistance paid for self or any other member of the recipient's assistance group renders the recipient ineligible for a medical assistance program, unless cooperation is waived by the department. Eligibility shall continue for any individual who cannot legally assign the individual's own rights and who would have been eligible for a medical assistance program but for the refusal to assign the individual's rights or to cooperate as required by this section by another person legally able to assign the individual's rights.
(D) If a medical assistance recipient or any member of the recipient's assistance group becomes ineligible for a medical assistance program, the department shall restore to the recipient or assistance group member any future rights to benefits assigned under this section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.39 | Third-Party Cooperation Regarding Liability Information.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) A third party shall cooperate with the department of medicaid in identifying individuals for the purpose of establishing third party liability regarding medical assistance programs.
(B) In furtherance of the requirement in division (A) of this section and to allow the department to determine any period that the individual or the individual's spouse or dependent may have been covered by the third party and the nature of the coverage, a third party shall provide, as the department so chooses, information or access to information, or both, in the third party's electronic data system on the department's request and in accordance with division (C) of this section.
(C)(1) If the department chooses to receive information directly, the third party shall provide the information under all of the following circumstances:
(a) In a medium, format, and manner prescribed in rules authorized by section 5160.43 of the Revised Code;
(b) Free of charge;
(c) Not later than the end of the thirtieth day after the department makes its request, unless a different time is agreed to by the director in writing.
(2) If the department chooses to receive access to information, the third party shall provide access by a method prescribed in rules authorized by section 5160.43 of the Revised Code. In facilitating access, the department may enter into a trading partner agreement with the third party to permit the exchange of information via "ASC X 12N 270/271 Health Care Eligibility Benefit Inquiry and Response" transactions.
(D) All of the following apply with respect to information provided by a third party to the department under this section:
(1) The information is confidential and not a public record under section 149.43 of the Revised Code.
(2) The release of information to the department is not to be considered a violation of any right of confidentiality or contract that the third party may have with covered persons including, but not limited to, contractees, beneficiaries, heirs, assignees, and subscribers.
(3) The third party is immune from any liability that it may otherwise incur through its release of information to the department.
The department shall limit its use of information gained from third parties to purposes directly connected with the administration of the medicaid program and the child support program authorized by Title IV-D of the "Social Security Act," 42 U.S.C. 651 et seq.
(E) No third party shall disclose to other parties or make use of any information regarding medical assistance recipients that it obtains from the department, except in the manner provided in rules authorized by section 5160.43 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.401 | Finality of Payments.

Effective:
September 29, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
(A) A payment made by a third party under division (B)(5) of section 5160.40 of the Revised Code on a claim for payment of a medical item or service provided to a medical assistance recipient is final on the date that is two years after the payment was made to the department of medicaid or the applicable medicaid managed care organization. After a claim is final, the claim is subject to adjustment only if an action for recovery of an overpayment was commenced under division (B) of this section before the date the claim became final and the recovery is agreed to by the department or medicaid managed care organization under division (C) of this section.
(B) If a third party determines that it overpaid a claim for payment, the third party may seek to recover all or part of the overpayment by filing a notice of its intent to seek recovery with the department or medicaid managed care organization, as applicable. The notice of recovery must be filed in writing before the date the payment is final. The notice must specify all of the following:
(1) The full name of the medical assistance recipient who received the medical item or service that is the subject of the claim;
(2) The date or dates on which the medical item or service was provided;
(3) The amount allegedly overpaid and the amount the third party seeks to recover;
(4) The claim number and any other number the department or medicaid managed care organization has assigned to the claim;
(5) The third party's rationale for seeking recovery;
(6) The date the third party made the payment and the method of payment used;
(7) If payment was made by check, the check number;
(8) Whether the third party would prefer to receive the amount being sought by obtaining a payment from the department or medicaid managed care organization, either by check or electronic means, or by offsetting the amount from a future payment to be made to the department or medicaid managed care organization.
(C) If the department or appropriate medicaid managed care organization determines that a notice of recovery was filed before the claim for payment is final and agrees to the amount sought by the third party, the department or medicaid managed care organization, as applicable, shall notify the third party in writing of its determination and agreement. Recovery of the amount shall proceed in accordance with the method specified by the third party pursuant to division (B)(8) of this section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.41 | Excluded Considerations for Third-Party Medical Assistance.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
No third party shall consider whether an individual is eligible for or enrolled in a medical assistance program when either of the following applies:
(A) The individual seeks to obtain a policy or enroll in a plan or program operated or administered by the third party;
(B) The individual, or a person or governmental entity on the individual's behalf, seeks payment for a medical item or service provided to the individual.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.42 | Sanctions Against Third Parties for Violations.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) If a third party violates section 5160.39, 5160.40, or 5160.41 of the Revised Code, a governmental entity that is responsible for issuing a license, certificate of authority, registration, or approval that authorizes the third party to do business in this state may impose a fine against the third party or deny, revoke, or terminate the third party's license, certificate, registration, or approval to do business in this state. The governmental entity shall determine which sanction is to be imposed. All actions to impose the sanction shall be taken in accordance with Chapter 119. of the Revised Code.
(B) In addition to the sanctions that may be imposed under division (A) of this section for a violation of section 5160.39, 5160.40, or 5160.41 of the Revised Code, the attorney general may petition a court of common pleas to enjoin the violation.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.43 | Adoption of Rules Regarding Recovery of Costs.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The medicaid director may adopt rules under section 5160.02 of the Revised Code to implement sections 5160.35 to 5160.43 of the Revised Code, including rules that specify what constitutes cooperating with efforts to obtain support or payments, or medical assistance payments, and when cooperation may be waived.
(B) The department shall adopt rules under section 5160.02 of the Revised Code to do all of the following:
(1) For purposes of the definition of "information" in division (A) of section 5160.35 of the Revised Code, any data other than the data specified in that division that should be included in the definition.
(2) For purposes of division (C)(1)(a) of section 5160.39 of the Revised Code, the medium, format, and manner in which a third party must provide information to the department.
(3) For purposes of division (C)(2) of section 5160.39 of the Revised Code, the method by which a third party must provide the department with access to information.
(C) Rules authorized by division (A) of this section may be adopted in accordance with section 111.15 of the Revised Code. Rules authorized by division (B) of this section shall be adopted in accordance with Chapter 119. of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.46 | Authorization Form.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) For the purposes of section 5160.45 of the Revised Code, an authorization shall be made on a form that uses language understandable to the average person and contains all of the following:
(1) A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion;
(2) The name or other specific identification of the person or class of persons authorized to make the requested use or disclosure;
(3) The name or other specific identification of the person or government entity to which the information may be released;
(4) A description of each purpose of the requested use or disclosure of the information;
(5) The date on which the authorization expires or an event related either to the individual who is the subject of the request or to the purposes of the requested use or disclosure, the occurrence of which will cause the authorization to expire;
(6) A statement that the information used or disclosed pursuant to the authorization may be disclosed by the recipient of the information and may no longer be protected from disclosure;
(7) The signature of the individual or the individual's authorized representative and the date on which the authorization was signed;
(8) If signed by an authorized representative, a description of the representative's authority to act for the individual;
(9) A statement of the individual or authorized representative's right to prospectively revoke the written authorization in writing, along with either of the following:
(a) A description of how the individual or authorized representative may revoke the authorization;
(b) If the department of medicaid has established a privacy notice that contains a description of how the individual or authorized representative may revoke the authorization, a reference to the privacy notice.
(10) A statement that treatment, payment, enrollment, or eligibility for a medical assistance program cannot be conditioned on signing the authorization unless the authorization is necessary for determining eligibility for the program.
(B) An authorization for the release of information regarding a medical assistance recipient to the recipient's attorney under division (D)(3) of section 5160.45 of the Revised Code may include a provision specifically authorizing the release of the recipient's electronic health records, if any, in accordance with rules authorized by section 5160.48 or 5160.481 of the Revised Code.
(C) When an individual requests information pursuant to section 5160.45 of the Revised Code regarding the individual's enrollment in a medical assistance program and does not wish to provide a statement of purpose, the statement "at request of the individual" is a sufficient description for purposes of division (A)(4) of this section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.47 | Membership in the Public Assistance Reporting Information System and Other Multistate Cooperatives.

Effective:
July 1, 2019
Latest Legislation:
House Bill 119 - 132nd General Assembly
(A) The department of medicaid shall do both of the following:
(1) Enter into any necessary agreements with the United States department of health and human services and neighboring states to join and participate as an active member in the public assistance reporting information system;
(2) Explore joining other multistate cooperatives, such as the national accuracy clearinghouse, to identify individuals enrolled in public assistance programs outside of this state.
(B) The department may disclose information regarding a medical assistance recipient to the extent necessary to participate as an active member in the public assistance reporting information system or other multistate cooperative.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.471 | Review to Determine Eligibility for Federal Military-Related Health Care Benefits.

Effective:
March 23, 2016
Latest Legislation:
Senate Bill 10 - 131st General Assembly
(A) As used in this section:
"Federal military-related health care benefits" means any of the health care benefits provided by the United States department of defense or the United States department of veterans affairs to current or former service members and their eligible dependents, including the benefits provided through the programs known as tricare and champva.
(B) (1) The department of medicaid shall review information in the public assistance reporting information system to determine whether an individual who is a medical assistance recipient may be eligible for federal military-related health care benefits. If the department determines that the individual may be eligible for federal military-related health care benefits, it shall notify the individual of the potential eligibility and encourage the individual to contact the veterans service commission in the county in which the individual resides for assistance in applying for the benefits. The department shall provide the appropriate contact information to the individual.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.48 | Rules for Conditions and Procedures for the Release of Information.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The medicaid director shall adopt rules under section 5160.02 of the Revised Code implementing sections 5160.45 to 5160.481 of the Revised Code and governing the custody, use, disclosure, and preservation of the information generated or received by the department of medicaid, county departments of job and family services, other state and county entities, contractors, grantees, private entities, or officials participating in the administration of medical assistance programs. The rules shall be adopted in accordance with Chapter 119. of the Revised Code. The rules may define who is an "authorized representative" for purposes of sections 5160.45 and 5160.46 of the Revised Code. The rules shall specify conditions and procedures for the release of information, which may include both of the following:
(1) Permitting a provider of a service under a medical assistance program limited access to information that is essential for the provider to render the service or to bill for the service rendered;
(2) Permitting a contractor, grantee, or other state or county entity limited access to information that is essential for the contractor, grantee, or entity to perform administrative or other duties on behalf of the department or a county department.
(B) The department of aging, when investigating a complaint under section 173.20 of the Revised Code, shall be granted any limited access permitted in the rules authorized by division (A)(1) of this section.
A contractor, grantee, or entity given access to information pursuant to the rules authorized by division (A)(2) of this section is bound by the director's rules. Disclosure of the information by the contractor, grantee, or entity in a manner not authorized by the rules is a violation of section 5160.45 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.481 | Adoption of Rules by Other Agencies.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
Whenever names, addresses, or other information relating to medical assistance recipients is held by any agency other than the department of medicaid or a county department of job and family services, that other agency shall adopt rules consistent with sections 5160.45 to 5160.481 of the Revised Code to prevent the publication or disclosure of names, lists, or other information concerning those recipients.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.50 | Refugee Medical Assistance Program.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The department of medicaid shall administer the refugee medical assistance program authorized by the "Immigration and Nationality Act," section 412(e), 8 U.S.C. 1522(e).
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.52 | Authority to Enter Into Interstate Compacts for Provision of Medical Assistance to Children.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid director may provide for the department of medicaid to develop, participate in the development of, negotiate, and enter into one or more interstate compacts on behalf of this state with agencies of any other states, for the provision of medical assistance to children in relation to whom all of the following apply:
(A) They have special needs.
(B) This state or another state that is a party to the interstate compact is providing adoption assistance on their behalf.
(C) They move into this state from another state or move out of this state to another state.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5160 | Medical Assistance Programs › Section 5160.99 | Penalty for Unlawful Disclosure of Information.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
Whoever violates division (B) of section 5160.45 of the Revised Code is guilty of a misdemeanor of the first degree.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.01 | Definitions.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) As used in the Revised Code, "children's health insurance program" and, when used as an acronym for the children's health insurance program, "CHIP" mean the program of child health assistance authorized by Title XXI of the "Social Security Act," 42 U.S.C. 1397aa et seq. CHIP part I, CHIP part II, and CHIP part III, as authorized by this chapter, are components of CHIP. Any reference in statute enacted by the general assembly to medicaid or the medicaid program also means CHIP to the extent, if any, that CHIP is provided under the medicaid program.
(B) As used in this chapter, "federal poverty line" means the official poverty line defined by the United States office of management and budget based on the most recent data available from the United States bureau of the census and revised by the United States secretary of health and human services pursuant to the "Omnibus Budget Reconciliation Act of 1981," section 673(2), 42 U.S.C. 9902(2).
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.02 | Rules for Administration of Chip.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid director may adopt rules in accordance with Chapter 119. of the Revised Code as necessary for the efficient administration of the children's health insurance program, including rules that establish all of the following:
(A) The conditions under which the program will pay for health benefits coverage;
(B) The method of the payment;
(C) The amount of payment, or the method by which the amount is to be determined, for each service included in the health benefits coverage.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.05 | Continued Operation of Federal Component.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid director may continue to operate the component of the children's health insurance program initially authorized by an executive order issued under section 107.17 of the Revised Code as long as federal financial participation is available for the program. If operated, the component shall pay for part or all of the cost of health benefits coverage for uninsured individuals under nineteen years of age with family incomes not exceeding one hundred fifty per cent of the federal poverty line.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.06 | Chip Part I.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The component of the children's health insurance program authorized by section 5161.05 of the Revised Code shall be known as CHIP part I.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.10 | State Child Health Plan.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
In accordance with federal law governing the children's health insurance program, the medicaid director may submit a state child health plan to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for part or all of the cost of health benefits coverage for uninsured individuals under nineteen years of age with family incomes above one hundred fifty per cent of the federal poverty line but not exceeding two hundred per cent of the federal poverty line. If the director submits the plan, the director shall stipulate in the plan that the payments will be available only while federal financial participation is available for them.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.11 | Chip Part Ii.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The component of the children's health insurance program authorized by section 5161.10 of the Revised Code shall be known as CHIP part II.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.12 | Implementation of Chip Part Ii.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
If the medicaid director submits a state child health plan to the United States secretary of health and human services under section 5161.10 of the Revised Code and the secretary approves the plan, the director shall implement CHIP part II in accordance with the plan. ; .
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.15 | Request for Waiver to Pay Costs for Certain Individuals.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
In accordance with federal law governing the children's health insurance program, the medicaid director may submit a request for a federal waiver to the United States secretary of health and human services to pay, except as provided in section 5161.22 of the Revised Code, for part or all of the cost of health benefits coverage for individuals under nineteen years of age with family incomes above two hundred per cent of the federal poverty line but not exceeding three hundred per cent of the federal poverty line. If the director submits the waiver request, the director shall stipulate in the request that the payments will be available only while federal financial participation is available for them.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.16 | Chip Part Iii.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The component of the children's health insurance program authorized by section 5161.15 of the Revised Code shall be known as CHIP part III.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.17 | Implementation of Chip Part Iii.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
If the medicaid director submits a waiver request to the United States secretary of health and human services under section 5161.15 of the Revised Code and the secretary grants the waiver, the director shall implement CHIP part III in accordance with the waiver.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.20 | Health Benefits Coverage.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
In accordance with the "Social Security Act," section 2101, 42 U.S.C. 1397aa, the children's health insurance program shall provide payments for obtaining health benefits coverage through any of the following:
(A) Obtaining coverage that meets the requirements the "Social Security Act," section 2103, of 42 U.S.C. 1397cc;
(B) Providing benefits under the medicaid program;
(C) A combination of divisions (A) and (B) of this section.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.22 | Imposing Restrictions Where Federal Financial Participation for Chip Parts II or III Insufficient.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
If the medicaid director determines that federal financial participation for CHIP part II, part III, or both parts is insufficient to pay for part or all of the costs of health benefits coverage for all the individuals the director anticipates are eligible for the part or parts, the director may refuse to accept new applications for the part or parts or may make the eligibility requirements more restrictive for the part or parts.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.24 | Cost-Sharing by Individual Receiving Health Assistance Under Chip Part Ii.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
To the extent permitted by the "Social Security Act," section 2103(e), 42 U.S.C. 1397cc(e), the medicaid director may require an individual seeking to enroll, or who is enrolled, in CHIP part II to pay a premium, deductible, coinsurance payment, or other cost-sharing expense.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.25 | Premium Payments.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
To the extent permitted by the "Social Security Act," section 2103(e), 42 U.S.C. 1397cc(e), the medicaid director shall require an individual seeking to enroll, or who is enrolled, in CHIP part III to pay the following as a term of enrollment:
(A) A premium of not less than forty dollars per month for a family with one individual seeking to enroll, or who is enrolled, in the part;
(B) A premium of not less than eighty dollars per month for a family with two individuals seeking to enroll, or who is enrolled, in the part;
(C) A premium of not less than one hundred twenty dollars per month for a family with three or more individuals seeking to enroll, or who are enrolled, in the part.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.27 | Application for Medicaid.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
A completed application for medicaid shall be treated as an application for the children's health insurance program if the application is for an assistance group that includes a child under nineteen years of age and is denied.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.30 | Contract to Perform Administrative Duties.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
The medicaid director may contract with a government entity or person to perform the director's administrative duties regarding CHIP part I, part II, part III, two of the parts, or all three parts, other than the duty to submit a state child health plan to the United States secretary of health and human services under section 5161.10 of the Revised Code, the duty to submit a waiver request under section 5161.15 of the Revised Code, and the duty to adopt rules under section 5161.02 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5161 | Children's Health Insurance Program › Section 5161.35 | Waiver Request to Provide Health Assistance to Certain Individuals.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(A) The medicaid director may submit a waiver request to the United States secretary of health and human services to provide health assistance to any individual who meets all of the following requirements:
(1) Is the parent of a child who is under nineteen years of age, resides with the parent, and is enrolled in the children's health insurance program part I or II or the medicaid program;
(2) Is uninsured;
(3) Has a family income that does not exceed one hundred per cent of the federal poverty line.
(B) A waiver request the director submits under division (A) of this section may seek federal funds allotted to the state under the "Social Security Act," section 2104, 42 U.S.C. 1397dd, that are not otherwise used to fund the children's health insurance program parts I and II.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.021 | Adoption of Rules by Other State Agencies.

Effective:
November 22, 2017
Latest Legislation:
House Bill 49 - 132nd General Assembly
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 administer pursuant to contracts entered into under section 5162.35 of the Revised Code.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.022 | Director's Rules Binding.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 political subdivision may establish, by rule or otherwise, a policy governing medicaid that is inconsistent with a medicaid policy established, in rule or otherwise, by the director.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.03 | Administration of Medicaid Program.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
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 requirements applicable to the single state agency.
2023 Ohio Revised Code › Title 51 | Public Welfare › Chapter 5162 | Medicaid and Medicaid Funds › Section 5162.031 | Powers of Director.

Effective:
September 29, 2013
Latest Legislation:
House Bill 59 - 130th General Assembly
(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 division (B) of this section;
(2) Assign duties to county departments of job and family services;
(3) Make payments to the United States department of health and human services from appropriations made to the department of medicaid for this purpose.
(B) Rules authorized by division (A)(1) of this section shall be adopted as follows:
(1) If the rules concern the department's duties regarding medicaid providers, under sections 5164.02 and 5165.02 of the Revised Code, as appropriate;
(2) If the rules concern the department's duties concerning individuals' eligibility for medicaid services, under section 5163.02 of the Revised Code;
(3) If the rules concern the department's duties concerning financial and operational matters between the department and county departments of job and family services, under section 5162.02 of the Revised Code.