(A) Under the medical assistance program:
(1) Reimbursement by the department of job and family services to a medical
provider for any medical service rendered under the program shall not exceed the
authorized reimbursement level for the same service under the medicare program
established under Title XVIII of the "Social Security Act," 49 Stat.
620 (1935), 42 U.S.C.A. 301, as amended.
(2) Reimbursement for freestanding medical laboratory charges shall not
exceed the customary and usual fee for laboratory profiles.
(3) The department may deduct from payments for services rendered by a
medicaid provider under the medical assistance program any amounts the provider
owes the state as the result of incorrect medical assistance payments the
department has made to the provider.
(4) The department may conduct final fiscal audits in accordance with the
applicable requirements set forth in federal laws and regulations and determine
any amounts the provider may owe the state. When conducting final fiscal audits,
the department shall consider generally accepted auditing standards, which
include the use of statistical sampling.
(5) To the maximum extent that federal laws and regulations permit the
implementation of such a policy, the department may institute a copayment
program for all services provided under the medical assistance program. The
program shall be administered in accordance with the applicable requirements set
forth in federal laws and regulations.
(6) The number of days of inpatient hospital care for which reimbursement is
made on behalf of a recipient of medical assistance to a hospital that is not
paid under a diagnostic-related-group prospective payment system shall not
exceed thirty days during a period beginning on the day of the recipient's
admission to the hospital and ending sixty days after the termination of that
hospital stay, except that the department may make exceptions to this
limitation. The limitation does not apply to children participating in the
program for medically handicapped children established under section 3701.023
[3701.02.3] of the Revised Code.
(B) The director of job and family services may adopt, amend, or rescind
rules under Chapter 119.
of the Revised Code establishing the amount, duration, and scope of medical
services to be included in the medical assistance program. Such rules shall
establish the conditions under which services are covered and reimbursed, the
method of reimbursement applicable to each covered service, and the amount of
reimbursement or, in lieu of such amounts, methods by which such amounts are to
be determined for each covered service. Any rules that pertain to nursing
facilities or intermediate care facilities for the mentally retarded shall be
consistent with sections 5111.20 to 5111.33 of the Revised Code.
(C) No health insuring corporation that has a contract to provide health care
services to recipients of medical assistance shall restrict the availability to
its enrollees of any prescription drugs included in the Ohio medicaid drug
formulary as established under rules adopted by the director.
(D) The division of any reimbursement between a collaborating physician or
podiatrist and a clinical nurse specialist, certified nurse-midwife, or
certified nurse practitioner for services performed by the nurse shall be
determined and agreed on by the nurse and collaborating physician or podiatrist.
In no case shall reimbursement exceed the payment that the physician or
podiatrist would have received had the physician or podiatrist provided the
entire service.
HISTORY: RC § 5101.51, 131 v 1210 (Eff 11-5-65); 133 v H 740 (Eff
11-14-69); 135 v S 318 (Eff 1-1-74); 135 v S 174 (Eff 12-4-73); 136 v H 1 (Eff
6-13-75); 136 v H 1546 (Eff 10-7-76); 137 v S 221 (Eff 11-23-77); 138 v H 204
(Eff 7-30-79); RC § 5111.02, 138 v H 176 (Eff 7-1-80); 138 v H 964 (Eff
7-1-80); 138 v H 1237 (Eff 9-30-80); 139 v H 1 (Eff 8-5-81); 139 v H 694 (Eff
11-15-81); 139 v S 550 (Eff 11-26-82); 140 v H 100 (Eff 2-24-83); 140 v H 291
(Eff 7-1-83); 140 v H 794 (Eff 7-6-84); 141 v H 238 (Eff 7-1-85); 142 v H 171
(Eff 7-1-87); 142 v S 196 (Eff 10-20-87); 142 v H 708 (Eff 4-19-88); 143 v H 111
(Eff 7-1-89); 143 v H 672 (Eff 11-14-89); 143 v H 822 (Eff 12-13-90); 144 v H
904 (Eff 12-22-92); 145 v H 152 (Eff 7-1-93); 146 v S 154 (Eff 9-10-96); 147 v S
67 (Eff 6-4-97); 148 v H 471. Eff 7-1-2000.
Not analogous to former RC § 5111.02 (GC § 6289-9; 119 v 384; Bureau of
Code Revision, 10-1-53), repealed 128 v 645, § 2, eff 9-7-59. The effective date is set by section 12(A) of HB 471.
© Copyright 2000
Containing legislation passed and filed through August 1, 2000.