Effective: September 29, 2015
Latest Legislation: House Bill 64 - 131st General Assembly
(A) A managed care organization that offers the health plan in which a healthy Ohio program participant enrolls shall issue a debit swipe card to be used to pay only for the following:
(1) Until the amount of the noncore portion of the participant's buckeye account is zero, the costs of health care services that are covered by the health plan and provided to the participant by a provider participating in the health plan;
(2) The participant's copayments under division (C) of section 5166.401 of the Revised Code;
(3) Subject to rules authorized by section 5166.409 of the Revised Code, the costs of health care services that are medically necessary for the participant but not covered by the health plan.
(B)(1) A healthy Ohio program participant's debit swipe card shall be credited with one point for each of the following:
(a) Each dollar of medicaid funds deposited into the participant's buckeye account under division (B) of section 5166.402 of the Revised Code;
(b) Each dollar contributed to the participant's buckeye account under divisions (C) and (D) of section 5166.402 of the Revised Code;
(c) Each point awarded to the participant under section 5166.404 of the Revised Code.
(2) Each time a healthy Ohio program participant uses the participant's debit swipe card, the amount for which the card is used shall be deducted from the number of points on the card as follows:
(a) If the card is used for the purpose specified in division (A)(1) of this section, the deduction shall come from the points representing the noncore portion of the participant's buckeye account.
(b) If the card is used for the purpose specified in division (A)(2) or (3) of this section, the deduction shall come from the points representing the core portion of the participant's buckeye account.
(C) A healthy Ohio program participant's debit swipe card shall do all of the following:
(1) Verify the participant's eligibility for the healthy Ohio program;
(2) Determine whether the service the participant seeks is covered under the health plan;
(3) Determine whether the provider from which the participant seeks the service is a participating provider under the health plan;
(4) Be linked to the participant's buckeye account in a manner that enables the participant to know at the point of service what will be deducted from the noncore portion and core portion of the participant's buckeye account for the service and how much will remain in each portion of the account after the deduction.
Structure Ohio Revised Code
Chapter 5166 | Federal Medicaid Waiver Programs
Section 5166.01 | Definitions.
Section 5166.02 | Rules Governing Medicaid Waiver Components.
Section 5166.03 | Notice of Intent to Request Medicaid Waiver.
Section 5166.04 | Home and Community-Based Services Medicaid Waiver Components.
Section 5166.05 | Review of Plans of Care and Individual Service Plans.
Section 5166.06 | Agency Records of Costs of Medicaid Waiver Components.
Section 5166.07 | Agency Accountable for Medicaid Waiver Components Funds.
Section 5166.08 | Agency Contracting for Medicaid Waiver Components; Assurance of Compliance.
Section 5166.10 | Transfer of Enrollee in One Medicaid Waiver Component to Another.
Section 5166.12 | Determination Regarding Continuation of the Ohio Home Care Waiver Program.
Section 5166.121 | Home First Component for the Ohio Home Care Waiver Program.
Section 5166.14 | Unified Long-Term Services and Support Medicaid Waiver Component.
Section 5166.16 | Integrated Care Delivery System Medicaid Waiver.
Section 5166.161 | Home and Community-Based Services for Holocaust Survivors.
Section 5166.20 | Additional Medicaid Waiver Components for Home and Community-Based Services.
Section 5166.21 | Transitions Developmental Disabilities Waiver.
Section 5166.22 | Allocating Enrollment Numbers to County Board of Developmental Disabilities.
Section 5166.30 | Coverage of Home Care Attendant Services.
Section 5166.301 | Home Care Attendant Services Providers.
Section 5166.302 | Continuing Education Requirements for Home Care Attendants.
Section 5166.303 | Responsibilities of Home Care Attendants.
Section 5166.304 | Nursing Assistance by Home Care Attendants.
Section 5166.305 | Nursing Assistance by Home Care Attendants; Consent and Authorization.
Section 5166.306 | Nursing Assistance by Home Care Attendants; Written Statement Providing Consent.
Section 5166.307 | Nursing Assistance by Home Care Attendants; Written Statement of Authorization.
Section 5166.308 | Nursing Assistance by Home Care Attendants; Unauthorized Actions.
Section 5166.3010 | Authorized Representative.
Section 5166.32 | Medicaid Waiver for Individuals With Cystic Fibrosis.
Section 5166.40 | Definitions.
Section 5166.401 | Enrolllment for Healthy Ohio Program Participants.
Section 5166.402 | Buckeye Accounts for Participants.
Section 5166.403 | Debit Swipe Cards.
Section 5166.404 | Points Award System.
Section 5166.405 | Cessation of Participation.
Section 5166.406 | Exhaustion of Payout Limits.
Section 5166.407 | Disqualification for Medicaid; Disposition of Remainder in Buckeye Account.
Section 5166.408 | Referral to Workforce Development Agency.