2006 Ohio Revised Code - [5111.01.12] 5111.0112.Copayment program.
(A) Not later than July 1, 2006, the director of job and family services shall institute a copayment program under the medicaid program. To the extent permitted by federal law, the copayment program shall establish a copayment requirement for only dental services, vision services, nonemergency emergency department services, and prescription drugs, other than generic drugs. The director shall adopt rules under section 5111.02 of the Revised Code governing the copayment program.
(B) The copayment program shall, to the extent permitted by federal law, provide for all of the following with regard to any providers participating in the medicaid program:
(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.
(3) Except as provided in division (C) of this section, no provider shall waive a medicaid recipient's obligation to pay the provider a copayment.
(4) 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.
(5) If it is the routine business practice of the 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 copayment program 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 individual of the provider's intent to refuse services.
(C) In the case of a provider that is a hospital, the copayment 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 (B)(3) of this section does not apply.
HISTORY: 149 v S 261. Eff 6-5-2002; 150 v H 95, § 1, eff. 9-26-03; 151 v H 66, § 101.01, eff. 9-29-05; 151 v H 530, § 101.01, eff. 6-30-06.
The effective date is set by § 812.03 of 151 v H 530.
The effective date is set by § 612.03 of 151 v H 66.
The effective date is set by section 179 of H.B. 95 (150 v - ).
Effect of Amendments
151 v H 530, effective June 30, 2006, in (A), added "program" to the end of the first sentence and "To the extent permitted by federal law" to the beginning, and deleted "to the extent permitted by federal statutes and regulations" from the end of the second sentence; added the exception to the beginning of (B)(3); and added (C).
151 v H 66, effective September 29, 2005, rewrote the section.
H.B. 95, Acts 2003, effective September 26, 2003, deleted "and which of those groups are appropriate for a copayment program designed to reduce inappropriate and excessive use of medical goods and services" following "statutes and regulations."
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