Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-70 - Hearing or Review for Providers › Section 5160-70-01 - Chapter 119. hearing or administrative reconsideration procedures for medicaid providers

Current through all regulations passed and filed through July 1, 2024
(A)
								 The following
			 definitions apply to Chapter 5160-70 of the Administrative Code:
(1)
									 "Appellant"
			 means the party who requested an adjudication hearing pursuant to Chapter 119.
			 of the Revised Code and is appealing the adjudication order to the Franklin
			 county court of common pleas.
(2)
									 "Certified mail"
			 means the United States postal service mail service in which the delivery
			 person obtains the signature of the recipient of the mail on a form as proof of
			 delivery to the specified addressee. Pursuant to section
			 1.02 of the Revised Code,
			 certified mail includes registered mail.
(3)
									 "Department"
			 means the Ohio department of medicaid ("ODM").
(4)
									 "Depository
			 agent" means the ODM office of legal services at its official mailing address
			 for the purpose of receiving correspondence or filings for any hearing held
			 under authority of Chapter 5160-70 of the Administrative Code.
(5)
									 "Director" means
			 the director of ODM.
(6)
									 "Adjudication order" means the order made by the
			 director after notice and an opportunity for a hearing is afforded pursuant to
			 Chapter 119. of the Revised Code.
(7)
									 "Final fiscal
			 audit" means a medicaid final rate settlement or a medicaid hospital final
			 settlement, including a final settlement in which Title V monies are offset
			 against medicaid monies proposed for adjudication by ODM.
(8)
									 "Hearing" means
			 a hearing held by ODM in compliance with sections
			 119.06 to
			 119.13 of the Revised
			 Code.
(9)
									 "Last known address" means the most recent mailing
			 address reported to ODM in compliance with reporting
			 requirements.
(10)
									 "Notice of intended action" means the written notice
			 to the party of the department's intended action and notice of the right to a
			 hearing pursuant to Chapter 119. of the Revised Code.
(11)
									 "ODM" means the
			 Ohio department of medicaid.
(12)
									 "Participants
			 in the hearing" means the party and the party's counsel in the hearing and ODM
			 and ODM's counsel in the hearing.
(13)
									 "Party" means a
			 person whose interests are the subject of a notice of intended action by
			 ODM.
(14)
									 "Person" means an individual, corporation, whether
			 nonprofit or for profit, a partnership, a limited liability company, and
			 unincorporated society or association.
(15)
									 "Medicaid
			 provider" or "provider" means a person or governmental entity with a valid
			 provider agreement to provide medical services or supplies to medicaid
			 recipients. To the extent appropriate in the context, "medicaid provider" or
			 "provider" includes a person or governmental entity applying for a provider
			 agreement, a former medicaid provider, or both.
(16)
									 "Notice by
			 ordinary mail" means the service obtained by the agency after the party fails
			 to claim the certified mail notice and the agency sends the notice by ordinary
			 mail using a certificate of mailing to the party's last known address and the
			 ordinary mail notice is not returned showing failure of
			 delivery.
(17)
									 "Provider agreement" means a contract between ODM and
			 a person or governmental entity that allows the person or governmental entity
			 to provide medical services and supplies for the Ohio medicaid
			 program.
(18)
									 "Take any action based on a final fiscal audit" means
			 ODM issuing a notice of intended action seeking recovery of medicaid
			 overpayments that were identified in the final fiscal audit.