Effective: September 29, 2017
Latest Legislation: House Bill 49 - 132nd General Assembly
(A) As used in this section:
"Anniversary date" means the later of the effective date of the provider agreement relating to the independent provider or sixty days after September 26, 2003.
"Applicant" means a person who has applied for a provider agreement to provide home and community-based services as an independent provider under a home and community-based medicaid waiver component administered by the department of medicaid.
"Criminal records check" has the same meaning as in section 109.572 of the Revised Code.
"Disqualifying offense" means any of the offenses listed or described in divisions (A)(3)(a) to (e) of section 109.572 of the Revised Code.
"Independent provider" means a person who has a provider agreement to provide home and community-based services as an independent provider in a home and community-based services medicaid waiver component administered by the department of medicaid.
(B) The department of medicaid or the department's designee shall deny an applicant's application for a provider agreement and shall terminate an independent provider's provider agreement if either of the following applies:
(1) After the applicant or independent provider is given the information and notification required by divisions (D)(2)(a) and (b) of this section, the applicant or independent provider fails to do either of the following:
(a) Access, complete, or forward to the superintendent of the bureau of criminal identification and investigation the form prescribed pursuant to division (C)(1) of section 109.572 of the Revised Code or the standard impression sheet prescribed pursuant to division (C)(2) of that section;
(b) Instruct the superintendent to submit the completed report of the criminal records check required by this section directly to the department or the department's designee.
(2) Except as provided in rules authorized by this section, the applicant or independent provider is found by either of the following to have been convicted of or have pleaded guilty to a disqualifying offense, regardless of the date of the conviction or the date of entry of the guilty plea:
(a) A criminal records check required by this section;
(b) In the case of an independent provider, a notice provided by the bureau of criminal identification and investigation under division (D) of section 109.5721 of the Revised Code.
(C)(1) The department or the department's designee shall inform each applicant, at the time of initial application for a provider agreement, that the applicant is required to provide a set of the applicant's fingerprint impressions and that a criminal records check is required to be conducted as a condition of the department's approving the application.
(2) Unless the department elects to receive notices about independent providers from the bureau of criminal identification and investigation pursuant to division (D) of section 109.5721 of the Revised Code, the department or the department's designee shall inform each independent provider on or before the time of the anniversary date of the provider agreement that the independent provider is required to provide a set of the independent provider's fingerprint impressions and that a criminal records check is required to be conducted.
(D)(1) The department or the department's designee shall require an applicant to complete a criminal records check prior to entering into a provider agreement with the applicant. The department or the department's designee shall require an independent provider to complete a criminal records check at least annually unless the department elects to receive notices about independent providers from the bureau of criminal identification and investigation pursuant to division (D) of section 109.5721 of the Revised Code. If an applicant or independent provider for whom a criminal records check is required by this section does not present proof of having been a resident of this state for the five-year period immediately prior to the date the criminal records check is requested or provide evidence that within that five-year period the superintendent of the bureau of criminal identification and investigation has requested information about the applicant or independent provider from the federal bureau of investigation in a criminal records check, the department or the department's designee shall request that the applicant or independent provider obtain through the superintendent a criminal records request from the federal bureau of investigation as part of the criminal records check of the applicant or independent provider. Even if an applicant or independent provider for whom a criminal records check request is required by this section presents proof of having been a resident of this state for the five-year period, the department or the department's designee may request that the applicant or independent provider obtain information through the superintendent from the federal bureau of investigation in the criminal records check.
(2) The department or the department's designee shall provide the following to each applicant and independent provider for whom a criminal records check is required by this section:
(a) Information about accessing, completing, and forwarding to the superintendent of the bureau of criminal identification and investigation the form prescribed pursuant to division (C)(1) of section 109.572 of the Revised Code and the standard impression sheet prescribed pursuant to division (C)(2) of that section;
(b) Written notification that the applicant or independent provider is to instruct the superintendent to submit the completed report of the criminal records check directly to the department or the department's designee.
(3) Each applicant and independent provider for whom a criminal records check is required by this section shall pay to the bureau of criminal identification and investigation the fee prescribed pursuant to division (C)(3) of section 109.572 of the Revised Code for the criminal records check conducted of the applicant or independent provider.
(E) Neither the report of any criminal records check conducted by the bureau of criminal identification and investigation in accordance with section 109.572 of the Revised Code and pursuant to a request made under this section nor a notice provided by the bureau under division (D) of section 109.5721 of the Revised Code is a public record for the purposes of section 149.43 of the Revised Code. Such a report or notice shall not be made available to any person other than the following:
(1) The person who is the subject of the criminal records check or the person's representative;
(2) The medicaid director and the staff of the department who are involved in the administration of the medicaid program;
(3) The department's designee;
(4) An individual receiving or deciding whether to receive home and community-based services from the person who is the subject of the criminal records check or notice from the bureau;
(5) A court, hearing officer, or other necessary individual involved in a case dealing with either of the following:
(a) A denial or termination of a provider agreement related to the criminal records check or notice from the bureau;
(b) A civil or criminal action regarding the medicaid program.
(F) The medicaid director shall adopt rules under section 5164.02 of the Revised Code to implement this section. The rules shall specify circumstances under which the department or the department's designee may either approve an applicant's application or allow an independent provider to maintain an existing provider agreement even though the applicant or independent provider is found by either of the following to have been convicted of or have pleaded guilty to a disqualifying offense:
(1) A criminal records check required by this section;
(2) In the case of an independent provider, a notice provided by the bureau of criminal identification and investigation under division (D) of section 109.5721 of the Revised Code.
Structure Ohio Revised Code
Chapter 5164 | Medicaid State Plan Services
Section 5164.01 | Definitions.
Section 5164.02 | Rules to Implement Chapter.
Section 5164.03 | Mandatory and Optional Services.
Section 5164.05 | Coverage of Services Provided by Outpatient Health Facilities.
Section 5164.06 | Medicaid Coverage of Occupational Therapy Services.
Section 5164.061 | Chiropractic Services.
Section 5164.07 | Coverage of Inpatient Care and Follow-Up Care for a Mother and Her Newborn.
Section 5164.08 | Breast Cancer and Cervical Cancer Screening.
Section 5164.09 | Equivalent Coverage for Orally and Intravenously Administered Cancer Medications.
Section 5164.091 | Coverage for Opioid Analgesics.
Section 5164.10 | Coverage of Tobacco Cessation Medications and Services.
Section 5164.14 | Medicaid Coverage for Health Care Service Provided by Pharmacist.
Section 5164.15 | Mental Health Services.
Section 5164.16 | Coverage of One or More State Plan Home and Community-Based Services.
Section 5164.17 | Medicaid Coverage of Tobacco Cessation Services.
Section 5164.20 | Medicaid Not to Cover Drugs for Erectile Dysfunction.
Section 5164.26 | Healthcheck Component.
Section 5164.29 | Revised Medicaid Provider Enrollment System.
Section 5164.291 | Provider Credentialing Committee.
Section 5164.30 | Provider Agreement With Department Required.
Section 5164.301 | Medicaid Provider Agreements for Physician Assistants.
Section 5164.31 | Funding for Implementing the Provider Screening Requirements.
Section 5164.32 | Expiration of Medicaid Provider Agreements.
Section 5164.33 | Denying, Terminating, and Suspending Provider Agreements.
Section 5164.34 | Criminal Records Check of Provider Personnel, Owners and Officers.
Section 5164.341 | Criminal Records Check by Independent Provider.
Section 5164.342 | Criminal Records Checks by Waiver Agencies.
Section 5164.35 | Provider Offenses.
Section 5164.37 | Suspension of Provider Agreement Without Notice.
Section 5164.38 | Adjudication Orders of Department.
Section 5164.39 | Hearing Not Required Unless Timely Requested.
Section 5164.44 | Employee Status of Independent Provider.
Section 5164.45 | Contracts for Examination, Processing, and Determination of Medicaid Claims.
Section 5164.46 | Electronic Claims Submission Process; Electronic Fund Transfers.
Section 5164.47 | Contracting for Review and Analysis, Quality Assurance and Quality Review.
Section 5164.471 | Summary Data Regarding Perinatal Services.
Section 5164.48 | Medicaid Payments Made to Organization on Behalf of Providers.
Section 5164.55 | Final Fiscal Audits.
Section 5164.56 | Lien for Amount Owed by Provider.
Section 5164.57 | Recovery of Medicaid Overpayments.
Section 5164.58 | Agency Action to Recover Overpayment to Provider.
Section 5164.59 | Deduction of Incorrect Payments.
Section 5164.60 | Interest on Medicaid Provider Excess Payments.
Section 5164.61 | Scope of Available Remedies for Recovery of Excess Payments.
Section 5164.70 | Limitations on Medicaid Payments for Services.
Section 5164.71 | Payments for Freestanding Medical Laboratory Charges.
Section 5164.72 | Limitations on Payments for Inpatient Hospital Care.
Section 5164.721 | Claims by Freestanding Birthing Centers.
Section 5164.73 | Division of Payments Between Physician or Podiatrist and Nurse.
Section 5164.74 | Reimbursement of Graduate Medical Education Costs.
Section 5164.741 | Payment for Graduate Medical Education Costs to Noncontracting Hospitals.
Section 5164.75 | Medicaid Payment for a Drug Subject to a Federal Upper Reimbursement Limit.
Section 5164.751 | State Maximum Allowable Cost Program.
Section 5164.752 | Determining Maximum Dispensing Fee.
Section 5164.753 | Dispensing Fee.
Section 5164.754 | Agreement for Multiple-State Drug Purchasing Program.
Section 5164.755 | Supplemental Drug Rebate Program.
Section 5164.757 | E-Prescribing Applications.
Section 5164.759 | Outpatient Drug Use Review Program.
Section 5164.7510 | Pharmacy and Therapeutics Committee.
Section 5164.7511 | Medication Synchronization for Medicaid Recipients.
Section 5164.7512 | Definitions for Sections 5164.7512 to 5164.7514.
Section 5164.7514 | Step Therapy Exemption Process.
Section 5164.7515 | Annual Benchmark for Prescribed Drug Spending Growth.
Section 5164.761 | Beta Testing of Updates to Billing Codes or Payment Rates.
Section 5164.78 | Medicaid Payment Rates for Certain Neonatal and Newborn Services.
Section 5164.80 | Public Notice for Changes to Payment Rates for Medicaid Assistance.
Section 5164.82 | Payment for Provider-Preventable Condition.
Section 5164.85 | Enrolling in Group Health Plan.
Section 5164.86 | Qualified State Long-Term Care Insurance Partnership Program.
Section 5164.88 | Coordinated Care Through Health Homes.
Section 5164.881 | Health Home Services.
Section 5164.89 | Case Management of Nonemergency Transportation Services.
Section 5164.90 | Transition of Medicaid Recipients to Community Settings.
Section 5164.91 | Integrated Care Delivery System.
Section 5164.911 | Integrated Care Delivery System Evaluation.
Section 5164.912 | Integrated Care Delivery System Standardized Claim Form.
Section 5164.92 | Advanced Diagnostic Imaging Services Coverage Under Medicaid Program.
Section 5164.93 | Incentive Payments for Adoption and Use of Electronic Health Record Technology.
Section 5164.94 | Delivery of Services in Culturally and Linguistically Appropriate Manners.
Section 5164.95 | Standards for Payments for Telehealth Services; Eligible Practitioners.
Section 5164.951 | Standards for Medicaid Payments for Services Provided Through Teledentistry.