Effective: September 18, 2020
Latest Legislation: House Bill 11 - 133rd General Assembly
(A) The department of medicaid shall institute cost-sharing requirements for the medicaid program. The department shall not institute cost-sharing requirements in a manner that does either of the following:
(1) Disproportionately impacts the ability of medicaid recipients with chronic illnesses to obtain medically necessary medicaid services;
(2) Violates section 5164.09 or 5164.10 of the Revised Code.
(B)(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.
(C) Except as provided in division (F) of this section, no provider shall waive a medicaid recipient's obligation to pay the provider a copayment.
(D) 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.
(E) If it is the routine business practice of a 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 cost-sharing requirements 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 recipient of the provider's intent to refuse service.
(F) In the case of a provider that is a hospital, the cost-sharing 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 (C) of this section does not apply.
(G) The department of medicaid may collaborate with a state agency that is administering, pursuant to a contract entered into under section 5162.35 of the Revised Code, one or more components, or one or more aspects of a component, of the medicaid program as necessary for the state agency to apply the cost-sharing requirements to the components or aspects of a component that the state agency administers.
Structure Ohio Revised Code
Chapter 5162 | Medicaid and Medicaid Funds
Section 5162.01 | Definitions.
Section 5162.02 | Rules for Implementation of Chapter.
Section 5162.021 | Adoption of Rules by Other State Agencies.
Section 5162.022 | Director's Rules Binding.
Section 5162.03 | Administration of Medicaid Program.
Section 5162.031 | Powers of Director.
Section 5162.04 | No State Cause of Action to Enforce Federal Laws.
Section 5162.05 | Implementation of Medicaid Program.
Section 5162.06 | Components Requiring Federal Approval or Funding.
Section 5162.07 | Federal Approval for Permissive Components Not Required.
Section 5162.10 | Review of Medicaid Program; Corrective Action; Sanctions.
Section 5162.11 | Contract for Data Collection and Warehouse Functions Assessment.
Section 5162.12 | Contracts for the Management of Medicaid Data Requests.
Section 5162.13 | Annual Report.
Section 5162.131 | Semiannual Reports on Controlling Increase in Costs.
Section 5162.132 | Annual Report Outlining Efforts to Minimize Fraud, Waste, and Abuse.
Section 5162.133 | Annual Program Report; Distribution; Contents.
Section 5162.134 | Annual Report of Integrated Care Delivery System Evaluation.
Section 5162.135 | Infant Mortality Scorecard.
Section 5162.1310 | Evaluation of Success of Expansion Eligibility Group.
Section 5162.15 | Information Required Where Annual Medicaid Payments Exceed $5 Million.
Section 5162.16 | Reporting Fraud, Waste, or Abuse.
Section 5162.20 | Cost-Sharing Requirements.
Section 5162.21 | Medicaid Estate Recovery Program.
Section 5162.211 | Lien Against Property of Recipient or Spouse as Part of Estate Recovery Program.
Section 5162.212 | Certification of Amounts Due Under Estate Recovery Program; Collection.
Section 5162.22 | Transfer of Personal Needs Allowance Account.
Section 5162.23 | Recovering Benefits Incorrectly Paid.
Section 5162.24 | Recovering Health Care Costs Provided to Child.
Section 5162.30 | Medicaid Administrative Claiming Program.
Section 5162.31 | Local Funds Expended for Administration of the Healthy Start Component.
Section 5162.32 | Contracts With Political Subdivisions to Pay Nonfederal Share.
Section 5162.35 | Contracts for Administration of Components.
Section 5162.36 | Medicaid School Component.
Section 5162.361 | Claim by Qualified Medicaid School Provider.
Section 5162.362 | Federal Financial Participation for Medicaid School Claims.
Section 5162.363 | Administration of Medicaid School Component.
Section 5162.364 | Adoption of Rules for Medicaid School Component.
Section 5162.365 | Responsibility for Repaying Overpayments.
Section 5162.366 | Referrals for Certain Services Under the Medicaid School Program.
Section 5162.37 | Contract Approval Required.
Section 5162.40 | Retaining or Collecting Percentage of Federal Financial Participation.
Section 5162.41 | Retaining or Collecting Percentage of Supplemental Payment.
Section 5162.50 | Health Care-Federal Fund.
Section 5162.52 | Health Care/medicaid Support and Recoveries Fund.
Section 5162.56 | Health Care Special Activities Fund.
Section 5162.65 | Refunds and Reconciliation Fund.
Section 5162.66 | Residents Protection Fund.
Section 5162.70 | Reforms to Medicaid Program.
Section 5162.71 | Implementation of Systems to Improve Health and Reduce Health Disparities.
Section 5162.72 | Strategies to Address Social Determinants of Health.
Section 5162.73 | Dental Services for Pregnant Medicaid Recipients.
Section 5162.75 | Notification of Veteran Services.
Section 5162.80 | Good Faith Estimates for Charges and Payments.