Effective: September 29, 2013
Latest Legislation: House Bill 59 - 130th General Assembly
(A) A medical assistance recipient may appeal a decision regarding the recipient's eligibility for a medical assistance program or services available to the recipient under a medical assistance program.
(B) Regarding appeals authorized by this section, the department of medicaid shall do one or more of the following:
(1) Administer an appeals process similar to the appeals process established under section 5101.35 of the Revised Code;
(2) Contract with the department of job and family services pursuant to section 5162.35 of the Revised Code to provide for the department of job and family services to hear the appeals in accordance with section 5101.35 of the Revised Code;
(3) Delegate authority to hear appeals to an exchange or exchange appeals entity.
(C) If a medical assistance recipient files an appeal as authorized by this section, the department of medicaid may do either or both of the following:
(1) Take corrective action regarding the matter being appealed before a hearing decision regarding the matter is issued;
(2) If a hearing decision, administrative appeal decision, or court ruling is against the recipient, take action in favor of the recipient despite the contrary decision or ruling, unless, in the case of a court's ruling, the ruling prohibits the department from taking the action.
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.