There is a newer version of the Ohio Revised Code
2012 Ohio Revised Code
Title [51] LI PUBLIC WELFARE
Chapter 5111 - MEDICAL ASSISTANCE PROGRAMS
- Section 5111.01 - Office of medical assistance; medicaid eligibility.
- Section 5111.011 - Determining eligibility for medical assistance.
- Section 5111.012 - Eligibility for medical assistance of persons living in county.
- Section 5111.013 - Healthy start program.
- Section 5111.014 - Medicaid plan amendment making pregnant individual eligible.
- Section 5111.015 - Tuition payment contract or scholarship excluded from income.
- Section 5111.016 - Healthcheck program.
- Section 5111.017 - [Repealed].
- Section 5111.018 - Coverage of inpatient care and follow-up care for a mother and her newborn.
- Section 5111.019 - [Renumbered as 5111.0120] Plan amendment making parent of child residing at home eligible.
- Section 5111.0110 - Breast and cervical cancer prevention and treatment.
- Section 5111.0111 - Individual receiving independent living services.
- Section 5111.0112 - Cost-sharing program.
- Section 5111.0113 - Children eligible for medical assistance through the medicaid program.
- Section 5111.0114 - Agreement for multiple-state drug purchasing program.
- Section 5111.0115 - Former Ohio works first participant ineligible due to employment.
- Section 5111.0116 - Disposal of assets under market value after look-back date.
- Section 5111.0117 - Real property not homestead after 13-month institutional residence.
- Section 5111.0118 - Equity interest in home exceeds $500,000.
- Section 5111.0119 - Confinement of medicaid recipient in correctional facility.
- Section 5111.0120 - Plan amendment making parent of child residing at home eligible.
- Section 5111.0121 - Redetermination of eligibility.
- Section 5111.0122 - Compliance with maintenance of effort requirement.
- Section 5111.0123 - Rules to reduce complexity regarding determination of medicaid eligibility.
- Section 5111.0124 - Implementation of the presumptive eligibility for pregnant women option.
- Section 5111.0125 - Medicaid state plan amendment; qualified entities for purposes of the presumptive eligibility for children option.
- Section 5111.02 - Rules establishing amount, duration and scope of services.
- Section 5111.021 - Reimbursement of providers.
- Section 5111.022 - Lien for amount owed by provider.
- Section 5111.023 - Mental health services.
- Section 5111.024 - Screening mammography and cytologic screening for cervical cancer.
- Section 5111.025 - Manner of payment for community mental health facilities and alcohol and drug addiction services.
- Section 5111.027 - Medicaid not to cover drugs for erectile dysfunction.
- Section 5111.028 - Time-limited medicaid provider agreements.
- Section 5111.029 - Medicaid coverage of occupational therapy services.
- Section 5111.0210 - Advanced diagnostic imaging services availability under medicaid program.
- Section 5111.0211 - Nursing facility not required to submit Medicaid claim for Medicare cost-sharing expenses under certain circumstances.
- Section 5111.0212 - Public notice for changes to medicaid reimbursement rate for medical assistance.
- Section 5111.0213 - Adjustment of medicaid payments; payment for aide or nursing services.
- Section 5111.0214 - Payment for provider-preventable condition.
- Section 5111.0215 - Incentive payments for adoption and use of electronic health record technology.
- Section 5111.03 - Provider offenses.
- Section 5111.031 - Action against noninstitutional medicaid provider.
- Section 5111.032 - Criminal records check of provider personnel, owners and officers.
- Section 5111.033 - Criminal records checks by waiver agencies.
- Section 5111.034 - Criminal records check by independent provider.
- Section 5111.035 - Creditable allegation of fraud; supsension of provider agreement.
- Section 5111.04 - Outpatient health facilities.
- Section 5111.041 - [Repealed].
- Section 5111.042 - Recipient with developmental disability who is eligible for medicaid case management services.
- Section 5111.05 - Contracts for examination, processing, and determination of medical assistance claims.
- Section 5111.051 - Medical assistance payments made to organization on behalf of providers.
- Section 5111.052 - Electronic claims submission process; electronic fund transfers.
- Section 5111.053 - Medicaid provider agreements for physician assistants.
- Section 5111.054 - Contracting for review and analysis, quality assurance and quality review.
- Section 5111.06 - Adjudication orders of department.
- Section 5111.061 - Recovery of medicaid overpayments.
- Section 5111.062 - Hearing not required unless timely requested.
- Section 5111.063 - Funding for implementing the provider screening requirements.
- Section 5111.07 - Determining maximum dispensing fee.
- Section 5111.071 - Dispensing fee.
- Section 5111.08 - Outpatient drug use review program.
- Section 5111.081 - Supplemental drug rebate program.
- Section 5111.082 - State maximum allowable cost program.
- Section 5111.083 - E-prescribing system.
- Section 5111.084 - Pharmacy and therapeutics committee.
- Section 5111.085 - Adoption of rules for implementation of coordinated services program for medicaid users who abuse prescription drugs.
- Section 5111.086 - Medicaid payment for a drug subject to a federal upper reimbursement limit.
- Section 5111.09 - Annual report.
- Section 5111.091 - Quarterly reports on controlling increase in costs.
- Section 5111.092 - Annual report outlining efforts to minimize medicaid fraud, waste, and abuse.
- Section 5111.10 - Review of medicaid program - corrective action - sanctions.
- Section 5111.101 - Information required where annual medicaid payments exceed $5 million.
- Section 5111.102 - No state cause of action to enforce federal laws.
- Section 5111.11 - Estate recovery program.
- Section 5111.111 - Lien against property of recipient or spouse as part of estate recovery program.
- Section 5111.112 - Certification of amounts due under estate recovery program - collection.
- Section 5111.113 - Transfer of personal needs allowance account.
- Section 5111.114 - Deducting personal needs allowance from recipient's income.
- Section 5111.12 - Recovering benefits incorrectly paid.
- Section 5111.121 - Recovering health care costs provided to child.
- Section 5111.13 - Enrolling in group health plan.
- Section 5111.14 - Coordinated care through health homes.
- Section 5111.141 - Case management of nonemergency transportation services.
- Section 5111.15 - Beneficiary of disability trust.
- Section 5111.151 - Eligibility determinations for cases involving medicaid programs.
- Section 5111.16 - Care management system.
- Section 5111.161 - Recognition of pediatric accountable care organizations.
- Section 5111.162 - Reference by managed care organization to noncontracting participant.
- Section 5111.163 - Payment of nonsystem provider for emergency services.
- Section 5111.17 - Managed care system.
- Section 5111.171 - Financial incentive awards.
- Section 5111.172 - Requiring coverage of prescription drugs for medicaid recipients.
- Section 5111.173 - Appointment of temporary manager.
- Section 5111.174 - Disenrolling some or all medicaid recipients enrolled in managed care organization under contract.
- Section 5111.175 - Records for determining costs.
- Section 5111.176 - Medicaid health insuring corporation franchise permit fee - managed care assessment fund.
- Section 5111.177 - Health insuring corporation contract to provide grievance process.
- Section 5111.178 - Application for federal medicaid requirements waiver.
- Section 5111.179 - Contracts with managed care organizations; Implementation of coordinated services program for medicaid recipients who abuse prescription drugs.
- Section 5111.1710 - Security agreements for managed care organization's use of drug database.
- Section 5111.1711 - Managed care performance payment program.
- Section 5111.18 - Qualified long-term care insurance partnership program.
- Section 5111.181 - Life insurance policies.
- Section 5111.19 - Reimbursement of graduate medical education costs.
- Section 5111.191 - Payment for graduate medical education costs to noncontracting hospitals.
- Section 5111.20 - Nursing facilities and intermediate care facilities for mentally retarded definitions.
- Section 5111.201 - Nursing facility references.
- Section 5111.202 - Admission of mentally ill person to nursing facility.
- Section 5111.203 - Hearing.
- Section 5111.204 - Assessment to determine level of care.
- Section 5111.205 - [Repealed].
- Section 5111.21 - Paying reasonable costs of services provided by eligible facility.
- Section 5111.211 - Responsibility for nonfederal share of claims submitted for services.
- Section 5111.212 - Payments made to facility for services provided after involuntary termination.
- Section 5111.22 - Provider agreement requirements.
- Section 5111.221 - Calculating rates and making payments.
- Section 5111.222 - [Effective Until 7/1/2013] Calculation of payments to nursing facility providers; quality bonus.
- Section 5111.222 - [Effective 7/1/2013] Calculation of payments to nursing facility providers; quality bonus.
- Section 5111.223 - Facility operator may contract with more than one provider.
- Section 5111.224 - Amount of payments to intermediate care facility for the mentally retarded pursuant to provider agreement.
- Section 5111.225 - Amount of payments for dual eligible individuals.
- Section 5111.226 - Assumption of powers and duties regarding medicaid program's coverage of services provided by intermediate care facilities for the mentally retarded.
- Section 5111.23 - Paying per resident per day rate for direct care costs.
- Section 5111.231 - [Effective Until 7/1/2013] Per resident per day rate for direct care costs.
- Section 5111.231 - [Effective 7/1/2013] Per resident per day rate for direct care costs.
- Section 5111.232 - Case-mix scores for nursing facilities.
- Section 5111.233 - Day programming.
- Section 5111.235 - Per resident per day rate for other protected costs.
- Section 5111.236 - Oxygen services for "medically fragile child".
- Section 5111.24 - [Effective Until 7/1/2013] Per resident per day rate for ancillary and support costs.
- Section 5111.24 - [Effective 7/1/2013] Per resident per day rate for ancillary and support costs.
- Section 5111.241 - Per resident per day rate for indirect care costs - intermediate care facility.
- Section 5111.242 - [Effective Until 7/1/2013] Per resident per day rate for tax costs.
- Section 5111.242 - [Effective 7/1/2013] Per resident per day rate for tax costs.
- Section 5111.243 - [Repealed] .
- Section 5111.244 - Quality incentive payments for qualifying nursing facilities.
- Section 5111.245 - Payment of quality bonus.
- Section 5111.246 - [Effective Until 7/1/2013] Critical access incentive payments to qualified facilities.
- Section 5111.246 - [Effective 7/1/2013] Critical access incentive payments to qualified facilities.
- Section 5111.25 - [Effective Until 7/1/2013] Per resident per day rate for reasonable capital costs.
- Section 5111.25 - [Effective 7/1/2013] Per resident per day rate for reasonable capital costs.
- Section 5111.251 - Per resident per day rate for reasonable capital costs - intermediate care facility.
- Section 5111.252 - Amended and Renumbered RC 5123.199.
- Section 5111.254 - Initial rates for nursing facility with first licensure date after June 30, 2006.
- Section 5111.255 - Initial rates for intermediate care facility for mentally retarded with first licensure date after June 30, 2006.
- Section 5111.257 - Rate for added, replaced, or renovated beds.
- Section 5111.258 - Calculating prospective rates for facilities with residents whose care costs are not otherwise adequately measured.
- Section 5111.259 - Centers of excellence component.
- Section 5111.26 - Annual cost report.
- Section 5111.261 - Amendments to cost reports.
- Section 5111.262 - Claim for medicaid reimbursement for service provided to nursing facility resident.
- Section 5111.263 - Limiting compensation of owners, their relatives, administrators, and resident meals outside facility.
- Section 5111.264 - Related party costs to pass through.
- Section 5111.265 - Cost of operating rights for relocated beds not allowable cost.
- Section 5111.266 - Cost of franchise permit fee not reimbursable expense.
- Section 5111.27 - Desk review of cost report.
- Section 5111.271 - Nursing facility fines.
- Section 5111.28 - Refund of certain payments by operators.
- Section 5111.29 - Reconsideration of rate.
- Section 5111.291 - Computing rate for intermediate care facilities.
- Section 5111.30 - Termination for non-compliance with installation of fire extinguishing and fire alarm systems.
- Section 5111.31 - Provider agreement to prohibit certain discriminatory actions.
- Section 5111.32 - Action against facility for breach of provider agreement or other duties.
- Section 5111.33 - Reserving bed during temporary absence of resident.
- Section 5111.331 - Payments made to reserve bed during temporary absence.
- Section 5111.34 - [Repealed] .
- Section 5111.341 - [Repealed].
- Section 5111.35 - Nursing facility deficiency definitions.
- Section 5111.36 - Adoption of rules.
- Section 5111.37 - Enforcement of rules.
- Section 5111.38 - Contracts with state agencies for enforcement.
- Section 5111.39 - Annual standard surveys.
- Section 5111.40 - Exit interview with administrator.
- Section 5111.41 - Citations for failure to comply with one or more certification requirements.
- Section 5111.411 - Survey results.
- Section 5111.42 - Statement of deficiencies.
- Section 5111.43 - Plan of correction.
- Section 5111.44 - On-site monitoring.
- Section 5111.45 - Deficiencies not substantially corrected.
- Section 5111.46 - Uncorrected deficiencies constituting severity level four findings.
- Section 5111.47 - Uncorrected deficiencies constituting severity level three and scope level three or four findings.
- Section 5111.48 - Uncorrected deficiencies constituting severity level one or two or severity level three, scope level two finding.
- Section 5111.49 - Imposing remedies and fines.
- Section 5111.50 - Fine collected if termination order does not take effect.
- Section 5111.51 - Emergency remedies.
- Section 5111.511 - Appointment of temporary resident safety assurance manager.
- Section 5111.52 - Terminating provider agreements.
- Section 5111.53 - Transfer of residents to other appropriate care settings.
- Section 5111.54 - Qualifications of temporary manager of nursing facility.
- Section 5111.55 - Residents to whom denial of medicaid payments applies.
- Section 5111.56 - Fines.
- Section 5111.57 - Order denying payment when deficiency is not corrected within time limits.
- Section 5111.58 - Termination of participation for failure to correct deficiency within six months.
- Section 5111.59 - Delivery of notices.
- Section 5111.60 - Appeals.
- Section 5111.61 - Confidentiality.
- Section 5111.62 - Residents protection fund.
- Section 5111.63 - Hearing on transfer or discharge of resident who medicaid or medicare beneficiary.
- Section 5111.65 - Notice of facility closure, etc. - definitions.
- Section 5111.651 - [Repealed] .
- Section 5111.66 - Notice of facility closure, termination, or withdrawal of participation.
- Section 5111.661 - Compliance with Social Security Act required.
- Section 5111.67 - Operator notice of intent to continue participation.
- Section 5111.671 - Provider agreement with entering operator.
- Section 5111.672 - Effective date of provider agreement with entering operator.
- Section 5111.673 - Entering operator duties under provider agreement.
- Section 5111.674 - Exiting operator deemed operator pending change.
- Section 5111.675 - Provider agreement with operator not complying with prior agreement.
- Section 5111.676 - Medicaid reimbursement adjustments - change of operator.
- Section 5111.677 - Determination of change of operator - excluded factors.
- Section 5111.68 - Overpayment amounts determined following notice of closure, etc.
- Section 5111.681 - Withholding from medicaid payment due exiting operator.
- Section 5111.682 - Cost report by exiting operator - waiver.
- Section 5111.683 - Failure to file cost report - payments deemed overpayments.
- Section 5111.684 - Final payment withheld pending receipt of cost reports.
- Section 5111.685 - Determination of debt of exiting operator - summary report.
- Section 5111.686 - Release of amount withheld less amounts owed.
- Section 5111.687 - Release of amount withheld on postponement of change of operator.
- Section 5111.688 - Disposition of amounts withheld from payment due an exiting operator.
- Section 5111.689 - Adoption of rules.
- Section 5111.70 - Medicaid buy-in for workers with disabilities program.
- Section 5111.701 - Qualifications for assistance under program.
- Section 5111.702 - Resource eligibility limit - annual adjustment.
- Section 5111.703 - Individual income eligibility limit.
- Section 5111.704 - Amount of annual individual premium.
- Section 5111.705 - Eligibility not denied due to RC 5111.851 services.
- Section 5111.706 - Continued participation where employment ceases.
- Section 5111.707 - Director to make federally required amendments.
- Section 5111.708 - Program implementing rules - disregarded income.
- Section 5111.709 - Medicaid buy-in advisory council.
- Section 5111.7010 - [Repealed] .
- Section 5111.7011 - Annual program report - distribution - contents.
- Section 5111.71 - Plan amendment for medicaid school component.
- Section 5111.711 - Claim by qualified medicaid school provider.
- Section 5111.712 - Federal financial participation for medicaid school claims.
- Section 5111.713 - Administration of medicaid school component.
- Section 5111.714 - Medicaid school program administrative fund.
- Section 5111.715 - Implementing rules for medicaid school component.
- Section 5111.74 - [Repealed].
- Section 5111.75 - [Repealed].
- Section 5111.76 - [Repealed].
- Section 5111.77, 5111.771 - [Repealed].
- Section 5111.78 to 5111.80 - [Repealed].
- Section 5111.81 - Amended and Renumbered to RC 5111.085.
- Section 5111.811 - [Repealed].
- Section 5111.82 - [Repealed].
- Section 5111.83 - Application for reimbursement under medicaid administrative claiming program.
- Section 5111.84 - Notice of intent to request medicaid waiver.
- Section 5111.85 - Medicaid waiver components.
- Section 5111.851 - Home and community-based services medicaid waiver components.
- Section 5111.852 - Review of plans of care and individual service plans.
- Section 5111.853 - Agency records of costs of medicaid waiver components.
- Section 5111.854 - Agency accountable for medicaid waiver components funds.
- Section 5111.855 - Agency contracting for medicaid waiver components - assurance of compliance.
- Section 5111.856 - Transfer of enrollee in one medicaid waiver component to another.
- Section 5111.86 - Creation of medicaid home and community-based services programs to replace former programs.
- Section 5111.861 - Ohio home care program .
- Section 5111.862 - Home first component for the Ohio home care program.
- Section 5111.863 - Ohio transitions II aging carve-out program.
- Section 5111.864 - Unified long-term services and support medicaid waiver component.
- Section 5111.865 - Home first component for unified long-term services and support medicaid waiver program.
- Section 5111.87 - Medicaid waivers.
- Section 5111.871 - Alternative to intermediate care facility for developmentally disabled.
- Section 5111.872 - Allocating enrollment numbers to county board of developmental disabilities.
- Section 5111.873 - Reimbursement for home and community-based services provided under component of the medicaid program.
- Section 5111.874 - Conversion of beds to home and community-based services.
- Section 5111.875 - Conversion of beds in acquired intermediate care facility.
- Section 5111.876 - Request for federal approval of conversion of beds.
- Section 5111.877 - Maximum number of beds approved.
- Section 5111.878 - Maximum number of beds converted.
- Section 5111.879 - Reconversion of beds to ICF/MR use.
- Section 5111.8710 - Implementing rules for conversion of beds.
- Section 5111.88 - Federal medicaid waivers authorizing components covering home care attendant services.
- Section 5111.881 - Home care attendant services providers.
- Section 5111.882 - Continuing education requirements for home care attendants.
- Section 5111.883 - Responsibilities of home care attendants.
- Section 5111.884 - Nursing assistance by home care attendants.
- Section 5111.885 - Nursing assistance by home care attendants - consent and authorization.
- Section 5111.886 - Nursing assistance by home care attendants - writtent statement providing consent.
- Section 5111.887 - Nursing assistance by home care attendants - written statement of authorization.
- Section 5111.888 - Nursing assistance by home care attendants - unauthorized actions.
- Section 5111.889 - Practice of nursing as registered nurse or licensed practical nurse not allowed by home care attendants.
- Section 5111.8810 - Authorized representative.
- Section 5111.8811 - Adoption of rules under section 5111.85.
- Section 5111.8812 - [Repealed].
- Section 5111.8813 - [Repealed].
- Section 5111.8814 - [Repealed].
- Section 5111.8815 - [Repealed].
- Section 5111.8816 - [Repealed].
- Section 5111.8817 - [Repealed].
- Section 5111.89 - Assisted living program.
- Section 5111.891 - Eligibility for assisted living program.
- Section 5111.892 - Eligibility requirements for state-funded component of assisted living program.
- Section 5111.893 - Staff requirements for assisted living program facility.
- Section 5111.894 - Home first component of the assisted living program.
- Section 5111.90 - Contracts with political subdivisions to pay nonfederal share.
- Section 5111.91 - Contracts for administration of components.
- Section 5111.911 - Contract approval required.
- Section 5111.912 - Department of mental health payment of nonfederal share of medicaid payment.
- Section 5111.913 - Department of alcohol and drug addiction services payment of nonfederal share of medicaid payment.
- Section 5111.914 - Agency action to recover overpayment to provider.
- Section 5111.915 - Contract for data collection and warehouse functions assessment.
- Section 5111.92 - Retaining or collecting percentage of federal financial participation.
- Section 5111.93 - Retaining or collecting percentage of supplemental payment.
- Section 5111.94 - Health care services administration fund.
- Section 5111.941 - Health care/medicaid support and recoveries fund.
- Section 5111.942 - Prescription drug rebates fund.
- Section 5111.943 - Health care-federal fund.
- Section 5111.944 - Integrated care delivery systems fund.
- Section 5111.945 - Health care special activities fund.
- Section 5111.946 - Health care compliance fund.
- Section 5111.95 - Amended and Renumbered RC 5111.033.
- Section 5111.96 - Transition of medicaid recipients to community settings.
- Section 5111.97 - Ohio access success project.
- Section 5111.971 - [Repealed] .
- Section 5111.98 - Powers of director regarding Medicare Prescription Act of 2003.
- Section 5111.981 - Demonstration project to evaluate integration of care dual eligible individuals receive.
- Section 5111.982 - .
- Section 5111.99 - Penalty.
Disclaimer: These codes may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.