Chapter 5164 - MEDICAID STATE PLAN SERVICES

Section 5164.01 - Definitions
Section 5164.02 - Rules to implement chapter
Section 5164.03 - Mandatory and optional services
Section 5164.05 - [Repealed]
Section 5164.06 - Medicaid coverage of occupational therapy services
Section 5164.061 - Chiropractic services
Section 5164.07 - Coverage of inpatient care and follow-up care for a mother and her newborn
Section 5164.071 - [Repealed Effective 10/3/2028] Doula program
Section 5164.072 - Coverage of donor breast milk and fortifiers
Section 5164.08 - Screening mammography and cytologic screening for cervical cancer
Section 5164.09 - Equivalent coverage for orally and intravenously administered cancer medications
Section 5164.091 - Coverage for opioid analgesics
Section 5164.092 - Advanced diagnostic imaging services coverage under medicaid program
Section 5164.10 - Coverage of tobacco cessation medications and services
Section 5164.14 - Medicaid coverage for health care service provided by pharmacist
Section 5164.15 - [Effective Until 1/1/2025] Mental health services
Section 5164.15 - [Effective 1/1/2025] Mental health services
Section 5164.16 - Coverage of one or more state plan home and community-based services
Section 5164.17 - Medicaid coverage of tobacco cessation services
Section 5164.20 - Medicaid not to cover drugs for erectile dysfunction
Section 5164.25 - Recipient with developmental disability who is eligible for medicaid case management services
Section 5164.26 - Healthcheck component
Section 5164.29 - Revised Medicaid provider enrollment system
Section 5164.291 - Credentialing program
Section 5164.30 - Provider agreement with department required
Section 5164.301 - Medicaid provider agreements for physician assistants
Section 5164.31 - Funding for implementing the provider screening requirements
Section 5164.32 - Expiration of medicaid provider agreements
Section 5164.33 - Denying, terminating, and suspending provider agreements
Section 5164.34 - Criminal records check of provider personnel, owners and officers
Section 5164.341 - Criminal records check by independent provider
Section 5164.342 - Criminal records checks by waiver agencies
Section 5164.35 - Provider offenses
Section 5164.36 - Credible allegation of fraud or disqualifying indictment; suspension of provider agreement
Section 5164.37 - Suspension of provider agreement without notice
Section 5164.38 - Adjudication orders of department
Section 5164.39 - Hearing not required unless timely requested
Section 5164.44 - Employee status of independent provider
Section 5164.45 - Contracts for examination, processing, and determination of medicaid claims
Section 5164.46 - Electronic claims submission process; electronic fund transfers
Section 5164.47 - Contracting for review and analysis, quality assurance and quality review
Section 5164.471 - Summary data regarding perinatal services
Section 5164.48 - Medicaid payments made to organization on behalf of providers
Section 5164.55 - Final fiscal audits
Section 5164.56 - Lien for amount owed by provider
Section 5164.57 - Recovery of medicaid overpayments
Section 5164.58 - Agency action to recover overpayment to provider
Section 5164.59 - Deduction of incorrect payments
Section 5164.60 - Interest on Medicaid provider excess payments
Section 5164.61 - Scope of available remedies for recovery of excess payments
Section 5164.70 - Limitations on medicaid payments for services
Section 5164.71 - Payments for freestanding medical laboratory charges
Section 5164.72 - Limitations on payments for inpatient hospital care
Section 5164.721 - Claims by freestanding birthing centers
Section 5164.73 - Division of payments between physician or podiatrist and nurse
Section 5164.74 - Reimbursement of graduate medical education costs
Section 5164.741 - Payment for graduate medical education costs to noncontracting hospitals
Section 5164.75 - Medicaid payment for a drug subject to a federal upper reimbursement limit
Section 5164.751 - State maximum allowable cost program
Section 5164.752 - Determining maximum dispensing fee
Section 5164.753 - Dispensing fee
Section 5164.754 - Agreement for multiple-state drug purchasing program
Section 5164.755 - Supplemental drug rebate program
Section 5164.756 - Drug rebate agreement or supplemental drug rebate agreement for medicaid program not subject to public records law
Section 5164.757 - E-prescribing applications
Section 5164.758 - Adoption of rules for implementation of coordinated services program for medicaid users who abuse prescription drugs
Section 5164.759 - Outpatient drug use review program
Section 5164.7510 - Pharmacy and therapeutics committee
Section 5164.7511 - Medication synchronization for medicaid recipients
Section 5164.7512 - Definitions for sections 5164.7512 to 5164.7514
Section 5164.7514 - Step therapy exemption process
Section 5164.7515 - Annual benchmark for prescribed drug spending growth
Section 5164.76 - Manner of payment for community mental health service providers or facilities and alcohol and drug addiction services
Section 5164.761 - Beta testing of updates to billing codes or payment rates
Section 5164.77 - [Repealed]
Section 5164.78 - Medicaid payment rates for certain neonatal and newborn services
Section 5164.80 - Public notice for changes to payment rates for medicaid assistance
Section 5164.82 - Payment for provider-preventable condition
Section 5164.85 - Enrolling in group health plan
Section 5164.86 - Qualified state long-term care insurance partnership program
Section 5164.88 - Coordinated care through health homes
Section 5164.881 - Health home services
Section 5164.89 - Case management of nonemergency transportation services
Section 5164.90 - Transition of medicaid recipients to community settings
Section 5164.91 - Integrated care delivery system
Section 5164.911 - Integrated care delivery system evaluation
Section 5164.912 - Integrated care delivery system standardized claim form
Section 5164.913 - Home health aide and personal care aide training
Section 5164.92 - Advanced diagnostic imaging services coverage under medicaid program
Section 5164.93 - Incentive payments for adoption and use of electronic health record technology
Section 5164.94 - Delivery of services in culturally and linguistically appropriate manners
Section 5164.95 - Standards for payments for telehealth services; eligible practitioners
Section 5164.951 - Standards for medicaid payments for services provided through teledentistry
Section 5164.96 - Ground emergency medical transportation supplemental payment program