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Chapter 5111: MEDICAL ASSISTANCE PROGRAMS

• 5111.01 Medicaid eligibility.
• 5111.011 Determining eligibility for medical assistance.
• 5111.012 Eligibility for medical assistance of persons living in county.
• 5111.013 Healthy start program.
• 5111.014 Medicaid plan amendment making pregnant individual eligible.
• 5111.015 Tuition payment contract or scholarship excluded from income.
• 5111.016 Healthcheck program.
• 5111.017 [Repealed].
• 5111.018 Coverage of inpatient care and follow-up care for a mother and her newborn.
• 5111.019 [Renumbered as 5111.0120] Plan amendment making parent of child residing at home eligible.
• 5111.0110 Breast and cervical cancer prevention and treatment.
• 5111.0111 Individual receiving independent living services.
• 5111.0112 Copayment program.
• 5111.0113 Children eligible for medical assistance through the medicaid program.
• 5111.0114 Agreement for multiple-state drug purchasing program.
• 5111.0115 Former Ohio works first participant ineligible due to employment.
• 5111.0116 Disposal of assets under market value after look-back date.
• 5111.0117 Real property not homestead after 13-month institutional residence.
• 5111.0118 Equity interest in home exceeds $500,000.
• 5111.0119 Confinement of medicaid recipient in correctional facility.
• 5111.0120 Plan amendment making parent of child residing at home eligible.
• 5111.0121 Redetermination of eligibility.
• 5111.02 Rules establishing amount, duration and scope of services.
• 5111.021 Reimbursement of providers.
• 5111.022 Lien for amount owed by provider.
• 5111.023 Mental health services.
• 5111.024 Screening mammography and cytologic screening for cervical cancer.
• 5111.025 Manner of payment for community mental health facilities and alcohol and drug addiction services.
• 5111.027 Medicaid not to cover drugs for erectile dysfunction.
• 5111.028 Time-limited medicaid provider agreements.
• 5111.029 Medicaid coverage of occupational therapy services.
• 5111.0210 Advanced diagnostic imaging services availability under medicaid program.
• 5111.0211 [Effective 9/13/2010] Nursing facility not required to submit Medicaid claim for Medicare cost-sharing expenses under certain circumstances.
• 5111.03 Provider offenses.
• 5111.031 Action against noninstitutional medicaid provider.
• 5111.032 Criminal records check of provider personnel.
• 5111.033 Criminal records checks by waiver agencies.
• 5111.034 Fingerprint impressions and criminal records check independent provider in department administered home and community-based waiver program.
• 5111.04 Outpatient health facilities.
• 5111.041 [Repealed].
• 5111.042 Recipient with developmental disability who is eligible for medicaid case management services.
• 5111.05 Contracts for examination, processing, and determination of medical assistance claims.
• 5111.06 Adjudication orders of department.
• 5111.061 Recovery of medicaid overpayments.
• 5111.062 Hearing not required unless timely requested.
• 5111.07 Determining maximum dispensing fee.
• 5111.071 Dispensing fee.
• 5111.08 Outpatient drug use review program.
• 5111.081 Supplemental drug rebate program.
• 5111.082 State maximum allowable cost program.
• 5111.083 E-prescribing system.
• 5111.084 Pharmacy and therapeutics committee.
• 5111.085 Transferred to 5111.084.
• 5111.09 Annual report.
• 5111.091 Quarterly reports on controlling increase in costs.
• 5111.092 Annual report outlining efforts to minimize medicaid fraud, waste, and abuse.
• 5111.10 Review of medicaid program - corrective action - sanctions.
• 5111.101 Information required where annual medicaid payments exceed $5 million.
• 5111.102 No state cause of action to enforce federal laws.
• 5111.11 Estate recovery program.
• 5111.111 Lien against property of recipient or spouse as part of estate recovery program.
• 5111.112 Certification of amounts due under estate recovery program - collection.
• 5111.113 Transfer of personal needs allowance account.
• 5111.114 Deducting personal needs allowance from recipient's income.
• 5111.12 Recovering benefits incorrectly paid.
• 5111.121 Recovering health care costs provided to child.
• 5111.13 Enrolling in group health plan.
• 5111.14 Case management of nonemergency transportation services.
• 5111.15 Beneficiary of disability trust.
• 5111.151 Eligibility determinations for cases involving medical assistance provided pursuant to this chapter.
• 5111.16 Care management system.
• 5111.161 [Repealed].
• 5111.162 Reference by managed care organization to noncontracting participant.
• 5111.163 Payment of nonsystem provider for emergency services.
• 5111.17 Managed care system.
• 5111.171 Financial incentive awards - health care compliance fund.
• 5111.172 Requiring coverage of prescription drugs for medicaid recipients.
• 5111.173 Appointment of temporary manager.
• 5111.174 Disenrolling some or all medicaid recipients enrolled in managed care organization under contract.
• 5111.175 Records for determining costs.
• 5111.176 Medicaid health insuring corporation franchise permit fee - managed care assessment fund.
• 5111.177 Health insuring corporation contract to provide grievance process.
• 5111.178 Application for federal medicaid requirements waiver.
• 5111.18 Qualified long-term care insurance partnership program.
• 5111.181 Life insurance policies.
• 5111.19 Reimbursement of graduate medical education costs.
• 5111.191 Payment for graduate medical education costs to noncontracting hospitals.
• 5111.20 Nursing facilities and intermediate care facilities for mentally retarded definitions.
• 5111.201 Nursing facility references.
• 5111.202 Admission of mentally ill person to nursing facility.
• 5111.203 Hearing.
• 5111.204 Assessment to determine level of care.
• 5111.205 [Repealed].
• 5111.21 [Effective Until 9/17/2010] Paying reasonable costs of services provided by eligible facility.
• 5111.211 Responsibility for nonfederal share of claims submitted for services.
• 5111.22 Provider agreement requirements.
• 5111.221 Calculating rates and making payments.
• 5111.222 Calculation of payments to nursing facility providers.
• 5111.223 Facility operator may contract with more than one provider.
• 5111.23 Paying per resident per day rate for direct care costs.
• 5111.231 Per resident per day rate for direct care costs.
• 5111.232 Case-mix scores for nursing facilities.
• 5111.233 Day programming.
• 5111.235 Per resident per day rate for other protected costs.
• 5111.236 Oxygen services for "medically fragile child".
• 5111.24 Per resident per day rate for ancillary and support costs.
• 5111.241 Per resident per day rate for indirect care costs - intermediate care facility.
• 5111.242 Per resident per day rate for tax costs.
• 5111.243 Per resident per day rate for franchise permit fees.
• 5111.244 Quality incentive payment for qualifying nursing facilities.
• 5111.25 Per resident per day rate for reasonable capital costs.
• 5111.251 Per resident per day rate for reasonable capital costs - intermediate care facility.
• 5111.252 Amended and Renumbered RC 5123.199.
• 5111.254 Initial rates for nursing facility with first licensure date after June 30, 2006.
• 5111.255 Initial rates for intermediate care facility for mentally retarded with first licensure date after June 30, 2006.
• 5111.257 Rate for added, replaced, or renovated beds.
• 5111.258 Calculating prospective rates for facilities with residents whose care costs are not otherwise adequately measured.
• 5111.26 Annual cost report.
• 5111.261 Limiting compensation of owners, their relatives, administrators, and resident meals outside facility.
• 5111.262 Claim for medicaid reimbursement for service provided to nursing facility resident.
• 5111.263 [Repealed].
• 5111.264 Related party costs to pass through.
• 5111.265 Cost of operating rights for relocated beds not allowable cost.
• 5111.266 Cost of franchise permit fee not reimbursable expense.
• 5111.27 Desk review of cost report.
• 5111.28 Refund of certain payments by operators.
• 5111.29 Reconsideration of rate.
• 5111.291 Computing rate for intermediate care facilities.
• 5111.30 Termination for non-compliance with installation of fire extinguishing and fire alarm systems.
• 5111.31 Provider agreement to prohibit certain discriminatory actions.
• 5111.32 Action against facility for breach of provider agreement or other duties.
• 5111.33 Reserving bed during temporary absence of resident.
• 5111.34 Report recommending methodology to transition paying providers.
• 5111.341 [Repealed].
• 5111.35 Nursing facility deficiency definitions.
• 5111.36 Adoption of rules.
• 5111.37 Enforcement of rules.
• 5111.38 Contracts with state agencies for enforcement.
• 5111.39 Annual standard surveys.
• 5111.40 Exit interview with administrator.
• 5111.41 Citations for failure to comply with one or more certification requirements.
• 5111.411 Survey results.
• 5111.42 Statement of deficiencies.
• 5111.43 Plan of correction.
• 5111.44 On-site monitoring.
• 5111.45 Deficiencies not substantially corrected.
• 5111.46 Uncorrected deficiencies constituting severity level four findings.
• 5111.47 Uncorrected deficiencies constituting severity level three and scope level three or four findings.
• 5111.48 Uncorrected deficiencies constituting severity level one or two or severity level three, scope level two finding.
• 5111.49 Imposing remedies and fines.
• 5111.50 Fine collected if termination order does not take effect.
• 5111.51 Emergency remedies.
• 5111.52 Terminating provider agreements.
• 5111.53 Transfer of residents to other appropriate care settings.
• 5111.54 Qualifications of temporary manager of nursing facility.
• 5111.55 Residents to whom denial of medicaid payments applies.
• 5111.56 Fines.
• 5111.57 Order denying payment when deficiency is not corrected within time limits.
• 5111.58 Termination of participation for failure to correct deficiency within six months.
• 5111.59 Delivery of notices.
• 5111.60 Appeals.
• 5111.61 Confidentiality.
• 5111.62 Residents protection fund.
• 5111.63 Hearing on transfer or discharge of resident who medicaid or medicare beneficiary.
• 5111.65 [Effective Until 8/31/2010] Notice of facility closure, etc. - definitions.
• 5111.651 [Effective Until 8/31/2010] Application of notice provisions.
• 5111.66 Notice of facility closure, termination, or withdrawal of participation.
• 5111.661 Compliance with Social Security Act required.
• 5111.67 Operator notice of intent to continue participation.
• 5111.671 Provider agreement with entering operator.
• 5111.672 Effective date of provider agreement with entering operator.
• 5111.673 Entering operator duties under provider agreement.
• 5111.674 Exiting operator deemed operator pending change.
• 5111.675 Provider agreement with operator not complying with prior agreement.
• 5111.676 Medicaid reimbursement adjustments - change of operator.
• 5111.677 Determination of change of operator - excluded factors.
• 5111.68 [Effective Until 8/31/2010] Overpayment amounts determined following notice of closure, etc.
• 5111.681 [Effective Until 8/31/2010] Withholding from medicaid payment due exiting operator.
• 5111.682 Cost report by exiting operator - waiver.
• 5111.683 Failure to file cost report - payments deemed overpayments.
• 5111.684 Final payment withheld pending receipt of cost reports.
• 5111.685 [Effective Until 8/31/2010] Determination of debt of exiting operator - summary report.
• 5111.686 [Effective Until 8/31/2010] Release of amount withheld less amounts owed.
• 5111.687 Release of amount withheld on postponement of change of operator.
• 5111.688 [Repealed Effective 8/31/2010] Rules prescribing medicaid reimbursement methodology.
• 5111.689 [Effective 8/31/2010] Rules prescribing medicaid reimbursement methodology.
• 5111.70 Medicaid buy-in for workers with disabilities program.
• 5111.701 Qualifications for assistance under program.
• 5111.702 Resource eligibility limit - annual adjustment.
• 5111.703 Individual income eligibility limit.
• 5111.704 Amount of annual individual premium.
• 5111.705 Eligibility not denied due to RC 5111.851 services.
• 5111.706 Continued participation where employment ceases.
• 5111.707 Director to make federally required amendments.
• 5111.708 Program implementing rules - disregarded income.
• 5111.709 Medicaid buy-in advisory council.
• 5111.7010 Consultation with advisory council.
• 5111.7011 Annual program report - distribution - contents.
• 5111.71 Plan amendment for medicaid school component.
• 5111.711 Claim by qualified medicaid school provider.
• 5111.712 Federal financial participation for medicaid school claims.
• 5111.713 Administration of medicaid school component.
• 5111.714 Medicaid school program administrative fund.
• 5111.715 Implementing rules for medicaid school component.
• 5111.74 [Repealed].
• 5111.75 [Repealed].
• 5111.76 [Repealed].
• 5111.77, 5111.771 [Repealed].
• 5111.78 to 5111.80 [Repealed].
• 5111.81 Amended and Renumbered to RC 5111.085.
• 5111.811 [Repealed].
• 5111.82 [Repealed].
• 5111.84 Notice of intent to request medicaid waiver.
• 5111.85 Medicaid waiver components.
• 5111.851 Home and community-based services medicaid waiver components.
• 5111.852 Review of plans of care and individual service plans.
• 5111.853 Agency records of costs of medicaid waiver components.
• 5111.854 Agency accountable for medicaid waiver components funds.
• 5111.855 Agency contracting for medicaid waiver components - assurance of compliance.
• 5111.856 Transfer of enrollee in one medicaid waiver component to another.
• 5111.86 Creation of medicaid home and community-based services programs to replace former programs.
• 5111.861 Consolidated federal medicaid waiver.
• 5111.87 Medicaid waivers.
• 5111.871 Alternative to intermediate care facility for mentally retarded.
• 5111.872 Allocating enrollment numbers to county board of developmental disabilities.
• 5111.873 Statewide fee schedules for home and community-based services provided under component of the medicaid program.
• 5111.874 [Effective Until 8/31/2010] Conversion of beds to home and community-based services.
• 5111.875 [Effective Until 8/31/2010] Conversion of beds in acquired intermediate care facility.
• 5111.876 Request for federal approval of conversion of beds.
• 5111.877 Maximum number of beds approved.
• 5111.878 Maximum number of beds converted.
• 5111.879 Reconversion of beds to ICF/MR use.
• 5111.8710 Implementing rules for conversion of beds.
• 5111.88 Federal medicaid waivers authorizing components covering home care attendant services.
• 5111.881 Home care attendant services providers.
• 5111.882 Continuing education requirements for home care attendants.
• 5111.883 Responsibilities of home care attendants.
• 5111.884 Nursing assistance by home care attendants.
• 5111.885 Nursing assistance by home care attendants - consent and authorization.
• 5111.886 Nursing assistance by home care attendants - writtent statement providing consent.
• 5111.887 Nursing assistance by home care attendants - written statement of authorization.
• 5111.888 Nursing assistance by home care attendants - unauthorized actions.
• 5111.889 Practice of nursing as registered nurse or licensed practical nurse not allowed by home care attendants.
• 5111.8810 Authorized representative.
• 5111.8811 Adoption of rules under section 5111.85.
• 5111.8812 [Repealed].
• 5111.8813 [Repealed].
• 5111.8814 [Repealed].
• 5111.8815 [Repealed].
• 5111.8816 [Repealed].
• 5111.8817 [Repealed].
• 5111.89 Request to HHS for waiver regarding assisted living program.
• 5111.891 Eligibility for assisted living program.
• 5111.892 Staff requirements for assisted living program facility.
• 5111.893 Contract for evaluation of program cost-effectiveness.
• 5111.894 [Effective Until 8/31/2010] Assisted living waiting lists - notice of admission - eligibility.
• 5111.90 Contracts with political subdivisions to pay nonfederal share.
• 5111.91 Contracts for administration of components.
• 5111.911 Contract approval required.
• 5111.912 Department of mental health payment of nonfederal share of medicaid payment.
• 5111.913 Department of alcohol and drug addiction services payment of nonfederal share of medicaid payment.
• 5111.914 Agency action to recover overpayment to provider.
• 5111.915 Contract for data collection and warehouse functions assessment.
• 5111.92 Retaining or collecting percentage of federal financial participation.
• 5111.93 Retaining or collecting percentage of supplemental payment.
• 5111.94 Health care services administration fund.
• 5111.941 Medicaid revenue and collections fund.
• 5111.942 Prescription drug rebates fund.
• 5111.943 Health care-federal fund.
• 5111.95 Amended and Renumbered RC 5111.033.
• 5111.96 Amended and Renumbered RC 5111.034.
• 5111.97 Ohio access success project.
• 5111.971 Request to HHS for waiver regarding health care services.
• 5111.98 Powers of director regarding Medicare Prescription Act of 2003.
• 5111.99 Penalty.