Effective: September 29, 2013
Latest Legislation: House Bill 59 - 130th General Assembly
(A) As used in this section, "OCHSPS" means the private, not-for-profit corporation known as the Ohio children's hospital solutions for patient safety, which was formed for the purpose of improving pediatric patient care in this state, which performs functions that are included within the functions of a peer review committee as defined in section 2305.25 of the Revised Code, and which consists of all of the following members: Akron children's hospital, Cincinnati children's hospital medical center, Cleveland clinic children's hospital, Dayton children's medical center, mercy children's hospital, nationwide children's hospital, rainbow babies & children's hospital, and Toledo children's hospital.
(B) If, as authorized by section 5160.10 of the Revised Code, the medicaid director chooses to contract with a person to perform either or both of the following services, the director may contract with any qualified person, including OCHSPS, to perform the service or services on behalf of the department of medicaid:
(1) Review and analyze claims for medicaid services provided to children in accordance with all state and federal laws governing the confidentiality of patient-identifying information;
(2) Perform quality assurance and quality review functions, other than those described in division (B)(1) of this section, related to medicaid services provided to children.
The functions specified in division (B)(2) of this section may include those recommended by the best evidence for advancing child health in Ohio now (BEACON) council.
(C) If the director enters into a contract with OCHSPS for OCHSPS to perform either or both of the services described in division (B) of this section, OCHSPS shall, only for purposes of section 5160.12 of the Revised Code, be considered a public entity and the director shall seek federal financial participation for costs incurred by OCHSPS in performing the service or services.
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.