Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-1 - General Provisions
Section 5160-1-16 - Preventive services
Universal Citation: OH Admin Code 5160-1-16
Current through all regulations passed and filed through September 16, 2024
(A) "Preventive service" is a procedure, treatment, or other measure that is included in either of two groups:
(1)
Services addressed in any of the following
sources:
(a)
"USPSTF A and B Recommendations" (January 2017), published
by the United States preventive services task force and available at
http://www.uspreventiveservicestaskforce.org;
(b)
Immunization
schedules for January 2017 published by the centers for disease control and
prevention and available at http://www.cdc.gov;
(c)
"Bright Futures: Guidelines for Health Supervision of
Infants, Children and Adolescents, 4th Edition" (2017), published by the
American academy of pediatrics and available at http://www.aap.org;
or
(d)
"Recommendations for Preventive Services for Women"
(December 2016), published by the women's preventive services initiative and
available at http://www.womenspreventivehealth.org; or
(2)
Medically
necessary procedures that meet the definition of "early and periodic screening,
diagnostic, and treatment services" set forth in
42
U.S.C. 1396d(r) (as in
effect in January 2017).
(B) Payment may be made for a preventive service and necessary related services (e.g., medications, procedures, devices, tests, education, and counseling) when both of the following conditions are met:
(1)
A practitioner in
an appropriate discipline, acting within the scope of practice authorized under
state law, has determined, on the basis of at least one risk factor, that the
preventive service is indicated for a particular individual;
and
(2)
The preventive service is provided in accordance with
nationally recognized, evidence-based frequency schedules.
Replaces: 5160-4-34
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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