Ohio Revised Code Chapter 5160 - Medical Assistance Programs

• Section 5160.01 - Defintions.
  As used in this chapter: (A) "Dual eligible individual" has the same meaning as in the "Social Security Act," section 1915(h)(2)(B), 42 U.S.C. 1396n(h)(2)(B)....
• Section 5160.011 - References To Department Or Director Of Other Agencies.
  References to the department or director of public welfare, department or director of human services, department or director of job and family services, office...
• Section 5160.02 - Rules.
  The medicaid director shall adopt rules as necessary to implement this chapter. Added by 130th General Assembly File No. 25, HB 59, §101.01, eff.
• Section 5160.021 - Adoption Of Rules.
  (A) When the medicaid director is authorized by a statute to adopt a rule, the director shall adopt the rule in accordance with the...
• Section 5160.03 - Authority Of Medicaid Director.
  The medicaid director is the executive head of the department of medicaid. All duties conferred on the department by law or order of the...
• Section 5160.04 - Assistant Director; Powers And Duties.
  The medicaid director shall appoint one assistant director for the department of medicaid. The assistant director shall exercise powers, and perform duties, as ordered...
• Section 5160.05 - Appointment Of Employees.
  The medicaid director may appoint such employees as are necessary for the efficient operation of the department of medicaid. The director may prescribe the...
• Section 5160.051 - Filling Positions With Peculiar And Exceptional Qualifications.
  If the medicaid director determines that a position with the department of medicaid can best be filled in accordance with division (A)(2) of section...
• Section 5160.052 - Procedures And Formats For Section 109.5721 Notices.
  The department of medicaid shall collaborate with the superintendent of the bureau of criminal identification and investigation to develop procedures and formats necessary to...
• Section 5160.06 - Fidelity Bonds.
  The medicaid director may require any of the employees of the department of medicaid who may be charged with custody or control of any...
• Section 5160.10 - Expending Funds.
  The medicaid director may expend funds appropriated or available to the department of medicaid from persons and government entities. For purposes of this section,...
• Section 5160.11 - State Health Care Grants Fund.
  The state health care grants fund is hereby created in the state treasury. Money the department of medicaid receives from private foundations in support...
• Section 5160.12 - Seeking Federal Financial Participation For Costs Incurred By Entity Implementing Program Administered By Department.
  (A) As used in this section, "entity" includes an agency, board, commission, or department of the state or a political subdivision of the state;...
• Section 5160.13 - Maximizing Receipt Of Federal Revenue.
  The department of medicaid may enter into contracts with private entities to maximize federal revenue without the expenditure of state money. In selecting private...
• Section 5160.16 - Appointment Of Agents.
  The department of medicaid may appoint and commission any competent person to serve as a special agent, investigator, or representative to perform a designated...
• Section 5160.20 - Audits And Investigations; Authority Of Department.
  (A) The department of medicaid may conduct any audits or investigations that are necessary in the performance of the department's duties, and to that...
• Section 5160.21 - Audit Of Medical Assistance Recipient.
  On the request of the medicaid director, the auditor of state may conduct an audit of any medical assistance recipient. If the auditor decides...
• Section 5160.22 - Examination Of Records Regarding Medical Assistance Programs.
  (A) The auditor of state and attorney general, or their designees, may examine any records, whether in computer or printed format, in the possession...
• Section 5160.23 - Audit Costs.
  The auditor of state is responsible for the costs the auditor incurs in carrying out the auditor's duties under sections 5160.21 and 5160.22 of...
• Section 5160.30 - Administrative Activities For Medical Assistance Programs.
  (A) Except as provided in divisions (B) and (C) of this section, the department of medicaid may accept applications, determine eligibility, redetermine eligibility, and...
• Section 5160.31 - Appeals Regarding Determination Of Eligiblity For Medical Assistance Program.
  (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...
• Section 5160.35 - [Renumbered From 5101.571] Recovery Of Medical Support Definitions.
  As used in sections 5160.35 to 5160.43 of the Revised Code: (A) "Information" means all of the following: (1) An individual's name, address, date...
• Section 5160.37 - [Renumbered From 5101.58] Right Of Recovery For Cost Of Medical Assistance.
  (A) A medical assistance recipient's enrollment in a medical assistance program gives an automatic right of recovery to the department of medicaid and a...
• Section 5160.371 - Disclosure Of Third-party Payer Information.
  In addition to the requirement of division (C) of section 5160.37 of the Revised Code to cooperate with the department of medicaid and county...
• Section 5160.38 - [Renumbered From 5101.59] Assignment Of Rights To Department.
  (A) The application for, or enrollment in, a medical assistance program constitutes an automatic assignment of rights specified in division (B) of this section...
• Section 5160.39 - [Renumbered From 5101.572] Third-party Cooperation Regarding Liability Information.
  (A) A third party shall cooperate with the department of medicaid in identifying individuals for the purpose of establishing third party liability regarding medical...
• Section 5160.40 - [Renumbered From 5101.573] Third-party Duties; Medicaid Managed Care Organizations.
  (A) Subject to divisions (B) and (C) of this section, a third party shall do all of the following: (1) Accept the department of...
• Section 5160.401 - Finality Of Payments.
  (A) A payment made by a third party under division (A)(4) of section 5160.40 of the Revised Code on a claim for payment of...
• Section 5160.41 - [Renumbered From 5101.574] Excluded Considerations For Third-party Medical Assistance.
  No third party shall consider whether an individual is eligible for or enrolled in a medical assistance program when either of the following applies:...
• Section 5160.42 - [Renumbered From 5101.575] Sanctions Against Third Parties For Violations.
  (A) If a third party violates section 5160.39, 5160.40, or 5160.41 of the Revised Code, a governmental entity that is responsible for issuing a...
• Section 5160.43 - [Renumbered From 5101.591] Adoption Of Rules Regarding Recovery Of Costs.
  (A) The medicaid director may adopt rules under section 5160.02 of the Revised Code to implement sections 5160.35 to 5160.43 of the Revised Code,...
• Section 5160.45 - [Renumbered From 5101.271] Disclosure Of Medical Assistance Information.
  (A) As used in sections 5160.45 to 5160.481 of the Revised Code, "information" means all of the following: (1) Records, as defined in section...
• Section 5160.46 - Authorization Form.
  (A) For the purposes of section 5160.45 of the Revised Code, an authorization shall be made on a form that uses language understandable to...
• Section 5160.47 - Membership In The Public Assistance Reporting Information System.
  The department of medicaid shall enter into any necessary agreements with the United States department of health and human services and neighboring states to...
• Section 5160.471 - [Effective 3/23/2016] Review To Determine Eligibility Forederal Military-related Health Care Benefits.
  (A) As used in this section:"Federal military-related health care benefits" means any of the health care benefits provided by the United States department of...
• Section 5160.48 - Rules For Conditions And Procedures For The Release Of Information.
  (A) The medicaid director shall adopt rules under section 5160.02 of the Revised Code implementing sections 5160.45 to 5160.481 of the Revised Code and...
• Section 5160.481 - Adoption Of Rules By Other Agencies.
  Whenever names, addresses, or other information relating to medical assistance recipients is held by any agency other than the department of medicaid or a...
• Section 5160.50 - Refugee Medical Assistance Program.
  The department of medicaid shall administer the refugee medical assistance program authorized by the "Immigration and Nationality Act," section 412(e), 8 U.S.C. 1522(e). Added...
• Section 5160.52 - Authority To Enter Into Interstate Compacts For Provision Of Medical Assistance To Children.
  The medicaid director may provide for the department of medicaid to develop, participate in the development of, negotiate, and enter into one or more...
• Section 5160.99 - Penalty For Unlawful Disclosure Of Information.
  Whoever violates division (B) of section 5160.45 of the Revised Code is guilty of a misdemeanor of the first degree. Added by 130th General...

Last modified: October 10, 2016