Revalidating medicare enrollment dating gta iv guide

Replaces: 5160-1-01 Effective: 3/22/2015Five Year Review (FYR) Dates: 03/22/2020Promulgated Under: 119.03 Statutory Authority: 5164.02 Rule Amplifies: 5164.02 Prior Effective Dates: 4/7/77, 9/19/77, 12/21/77, 12/30/77, 7/1/80, 2/19/82, 10/1/84, 10/1/87, 6/1/91, 5/30/02, 07/01/2006 This rule describes general principles regarding reimbursement of services by medicaid.

Reimbursement may be subject to additional administrative criteria as described in division 5101:3 of the Administrative Code.(A) A medical service is reimbursable if:(1) The service is determined medically necessary as defined in rule 5101:3-1-01 of the Administrative Code.

(2) The service is free to the public, except when medicaid reimbursement for such services is prescribed by federal law.

(3) The service is a provider-preventable condition as defined in 42 CFR 447.26. 1396n (c) (5)) are covered under medicaid only when:(1) They are a part of services provided in an intermediate care facility for persons with mental retardation (ICF/MR), or (2) They are included under a federally approved home and community-based services (HCBS) waiver, and are medically necessary services identified in an enrollee's particular HCBS waiver. 730 are not reimbursable through federally approved waivers. 119.032 review dates: 08/01/2016Promulgated Under: 119.03 Statutory Authority: 5111.02 Rule Amplifies: 5111.01, 5111.02 Prior Effective Dates: 4/7/77, 9/19/77, 12/21/77, 12/30/77, 7/1/80, 2/19/82, 10/1/84, 10/1/87, 6/1/91, 5/30/02, 7/1/06 (A) For persons eligible under both medicaid, administered by the Ohio department of medicaid (ODM), and the children with medical handicaps (CMH) program, administered by the Ohio department of health (ODH), medicaid is the first payer of health care claims (unless a consumer has third party insurance and/or is a medicare beneficiary, then rules 5160-1--1-08 of the Administrative Code regarding coordination of benefits with a primary payer apply) and its payment constitutes payment in full.

(13) "Routine" means commonplace, regular, habitual, or ordinary.

(4) The service is provided within the limits of the consumer's medicaid or medicaid managed care plan benefit package.

(5) The service is provided within the scope of practice of the rendering provider as defined by applicable federal, state, and local laws and regulations.

(14) "Routine information that is maintained for the purpose of internal office administration, the use of which would not adversely affect a person" as that phrase is used in division (F) of section 1347.01 of the Revised Code means personal information relating to employees and maintained by the agency for internal administrative and human resource purposes.

(15) "System or Information System" As defined in section 1347.01 of the Revised Code, "system" means any collection or group of related records that are kept in an organized manner and that are maintained by a state or local agency, and from which personal information is retrieved using the person's name or by an identifying number, symbol, or other identifier assigned to the person.

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