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Section 5160-1-03 - [Rescinded] Medicaid: relationship to the children with medical handicaps program under Title V of the Social Security Act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Section 5160-1-06 - [Rescinded] Home and community-based service waivers: general description
Section 5160-1-06.1 - Home and community-based service waivers: PASSPORT
Section 5160-1-06.4 - [Rescinded] Home and community-based services (HCBS) waivers: choices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Section 5160-1-15 - [Rescinded] Medicaid card
Section 5160-1-16 - Preventive services
Section 5160-1-17 - Eligible providers
Section 5160-1-17.1 - [Rescinded] Notification of rule and program changes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Section 5160-1-19.1 - [Rescinded] References to the "International Classification of Diseases (ICD)"
Section 5160-1-19.9 - [Rescinded] Inquiries regarding the status of claims [except for services provided through a medicaid managed care program]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 - [Rescinded] 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 [except for services provided through medicaid contracting managed care plans (MCPs)]
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 - [Rescinded] Process for provider appeals from proposed departmental actions
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 - [Rescinded]
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