Effective: September 29, 2013
Latest Legislation: House Bill 59 - 130th General Assembly
As used in this chapter:
(A) "Dual eligible individual" has the same meaning as in the "Social Security Act," section 1915(h)(2)(B), 42 U.S.C. 1396n(h)(2)(B). A dual eligible individual is a medicare-medicaid enrollee (MME).
(B) "Exchange" has the same meaning as in 45 C.F.R. 155.20.
(C) "Federal financial participation" means the federal government's share of expenditures made by an entity in implementing a medical assistance program.
(D) "Medical assistance program" means all of the following:
(1) The medicaid program;
(2) The children's health insurance program;
(3) The refugee medical assistance program;
(4) Any other program that provides medical assistance and state statutes authorize the department of medicaid to administer.
(E) "Medical assistance recipient" means a recipient of a medical assistance program. To the extent appropriate in the context, "medical assistance recipient" includes an individual applying for a medical assistance program, a former medical assistance recipient, or both.
(F) "Medicaid managed care organization" has the same meaning as in section 5167.01 of the Revised Code.
(G) "Refugee medical assistance program" means the program that the department of medicaid administers pursuant to section 5160.50 of the Revised Code.
Structure Ohio Revised Code
Chapter 5160 | Medical Assistance Programs
Section 5160.01 | Definitions.
Section 5160.011 | References to Department or Director of Other Agencies.
Section 5160.021 | Adoption of Rules.
Section 5160.03 | Authority of Medicaid Director.
Section 5160.04 | Assistant Director; Powers and Duties.
Section 5160.05 | Appointment of Employees.
Section 5160.051 | Filling Positions With Peculiar and Exceptional Qualifications.
Section 5160.052 | Procedures and Formats for Section 109.5721 Notices.
Section 5160.06 | Fidelity Bonds.
Section 5160.10 | Expending Funds.
Section 5160.11 | State Health Care Grants Fund.
Section 5160.13 | Maximizing Receipt of Federal Revenue.
Section 5160.16 | Appointment of Agents.
Section 5160.20 | Audits and Investigations; Authority of Department.
Section 5160.21 | Audit of Medical Assistance Recipient.
Section 5160.22 | Examination of Records Regarding Medical Assistance Programs.
Section 5160.23 | Audit Costs.
Section 5160.29 | Verification of Eligibility for Medical Assistance Program.
Section 5160.291 | Changes Affecting Eligibility.
Section 5160.292 | Medicaid Eligibility Fraud.
Section 5160.293 | Construction.
Section 5160.30 | Administrative Activities for Medical Assistance Programs.
Section 5160.31 | Appeals Regarding Determination of Eligibility for Medical Assistance Program.
Section 5160.34 | Medical Assistance Programs With Prior Authorization Requirements.
Section 5160.35 | Recovery of Medical Support Definitions.
Section 5160.37 | Right of Recovery for Cost of Medical Assistance.
Section 5160.371 | Disclosure of Third-Party Payer Information.
Section 5160.38 | Assignment of Rights to Department.
Section 5160.39 | Third-Party Cooperation Regarding Liability Information.
Section 5160.40 | Third-Party Duties; Medicaid Managed Care Organizations.
Section 5160.401 | Finality of Payments.
Section 5160.41 | Excluded Considerations for Third-Party Medical Assistance.
Section 5160.42 | Sanctions Against Third Parties for Violations.
Section 5160.43 | Adoption of Rules Regarding Recovery of Costs.
Section 5160.45 | Disclosure of Medical Assistance Information.
Section 5160.46 | Authorization Form.
Section 5160.48 | Rules for Conditions and Procedures for the Release of Information.
Section 5160.481 | Adoption of Rules by Other Agencies.
Section 5160.50 | Refugee Medical Assistance Program.
Section 5160.99 | Penalty for Unlawful Disclosure of Information.