Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-1 - General Provisions
- Section 5160-1-01 - Medicaid medical necessity: definitions and principles
- Section 5160-1-02 - General reimbursement principles
- Section 5160-1-03 - Medicaid: relationship to the children with medical handicaps program under Title V of the Social Security Act
- Section 5160-1-04 - Employee access to confidential personal information
- Section 5160-1-05 - Medicaid coordination of benefits with the medicare program (Title XVIII)
- Section 5160-1-05.1 - Payment for "Medicare Part C" cost sharing
- Section 5160-1-05.3 - Payment for "Medicare Part B" cost sharing
- Section 5160-1-06 - Home and community-based service waivers: general description
- Section 5160-1-06.1 - Home and community-based service waivers: PASSPORT
- Section 5160-1-06.1 - Home and community-based service waivers: PASSPORT
- Section 5160-1-06.4 - Home and community-based services (HCBS) waivers: choices
- Section 5160-1-06.5 - Home and community based services (HCBS) waivers: assisted living
- Section 5160-1-08 - Coordination of benefits
- Section 5160-1-09 - Co-payments
- Section 5160-1-10 - Limitations on elective obstetric deliveries
- Section 5160-1-11 - Out-of-state coverage
- Section 5160-1-13.1 - Medicaid recipient liability
- Section 5160-1-14 - Healthchek: early and periodic screening, diagnostic, and treatment (EPSDT) covered services
- Section 5160-1-15 - Medicaid card
- Section 5160-1-16 - Preventive services
- Section 5160-1-17 - Eligible providers
- Section 5160-1-17.1 - Notification of rule and program changes
- Section 5160-1-17.2 - Provider agreement for providers
- Section 5160-1-17.3 - Provider disclosure requirements
- Section 5160-1-17.4 - Revalidation of provider agreements
- Section 5160-1-17.5 - Suspension of medicaid provider agreements
- Section 5160-1-17.6 - Termination and denial of provider agreement
- Section 5160-1-17.7 - Application by a former participating medicaid provider to resume participation in the Ohio medicaid program [except for medicaid contracting managed care plans (MCPs)]
- Section 5160-1-17.8 - Provider screening and application fee
- Section 5160-1-17.9 - Ordering or referring providers
- Section 5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility
- Section 5160-1-18 - Telehealth
- Appendix to rule 5160-1-18
- Section 5160-1-19 - Submission of medicaid claims
- Section 5160-1-19.1 - References to the "International Classification of Diseases (ICD)"
- Section 5160-1-19.9 - Inquiries regarding the status of claims [except for services provided through a medicaid managed care program]
- Section 5160-1-20 - Electronic data interchange (EDI) trading partner enrollment and testing
- Section 5160-1-23 - Assignment of provider claims
- Section 5160-1-25 - Interest on overpayments made to medicaid providers
- Section 5160-1-27 - Review of provider records
- Section 5160-1-27.1 - Hold and review process
- Section 5160-1-27.2 - Medicaid hold and review process for medicaid claims paid through state agencies other than the Ohio department of medicaid
- Section 5160-1-29 - Medicaid fraud, waste, and abuse
- Section 5160-1-31 - Prior authorization
- Section 5160-1-32 - Medicaid: safeguarding and releasing information
- Section 5160-1-32.1 - Standard authorization form
- Section 5160-1-33 - Medicaid: authorized representatives
- Section 5160-1-39 - Verification of home care service provision to home care dependent adults
- Section 5160-1-40 - Electronic visit verification (EVV)
- Section 5160-1-42 - Provider credentialing
- Section 5160-1-42.1 - Delegated credentialing
- Section 5160-1-57 - Process for provider appeals from proposed departmental actions
- Section 5160-1-60 - Medicaid payment
- Section 5160-1-60 - Medicaid payment
- Section 5160-1-60.1 - Special provisions for reimbursement for physician groups acting as outpatient hospital clinics
- Section 5160-1-60.2 - Direct reimbursement for out-of-pocket expenses incurred for medicaid covered services during approved eligibility periods
- Section 5160-1-60.3
- Section 5160-1-60.4 - By-report procedures, services, and supplies
- Section 5160-1-61 - Non-covered services
- Section 5160-1-70 - Relocated provisions concerning episode based payments
- Section 5160-1-71 - Relocated provisions concerning patient centered medical homes (PCMH) and eligible providers
- Section 5160-1-72 - Relocated provisions concerning patient centered medical homes (PCMH) and payments
- Section 5160-1-73 - Behavioral health care coordination
- Section 5160-1-80 - Substitute practitioners (locum tenens)
- Section 5160-1-97 - One-time medicaid provider relief payments
- Section 5160-1-98 - Deposits to the health care/medicaid support and recoveries fund for program support
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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