CHAPTER 5160-1 - General Provisions (Sec. 5160-1-01 to Sec. 5160-1-80)

  1. Sec. 5160-1-01 - Medicaid medical necessity: definitions and principles
  2. Sec. 5160-1-02 - General reimbursement principles
  3. Sec. 5160-1-03 - Medicaid: relationship to the children with medical handicaps program under Title V of the Social Security Act
  4. Sec. 5160-1-04 - Employee access to confidential personal information
  5. Sec. 5160-1-05 - Medicaid coordination of benefits with the medicare program (Title XVIII)
  6. Sec. 5160-1-05.1 - Payment for "Medicare Part C" cost sharing
  7. Sec. 5160-1-05.3 - Payment for "Medicare Part B" cost sharing
  8. Sec. 5160-1-06 - [Rescinded]Home and community-based service waivers: general description
  9. Sec. 5160-1-06.1 - Home and community-based service waivers: PASSPORT
  10. Sec. 5160-1-06.4 - [Rescinded]Home and community-based services (HCBS) waivers: choices
  11. Sec. 5160-1-06.5 - Home and community based services (HCBS) waivers: assisted living
  12. Sec. 5160-1-08 - Coordination of benefits
  13. Sec. 5160-1-09 - Co-payments
  14. Sec. 5160-1-10 - Limitations on elective obstetric deliveries
  15. Sec. 5160-1-11 - Out-of-state coverage
  16. Sec. 5160-1-13.1 - Medicaid recipient liability
  17. Sec. 5160-1-14 - Healthchek: early and periodic screening, diagnostic, and treatment (EPSDT) covered services
  18. Sec. 5160-1-15 - [Rescinded]Medicaid card
  19. Sec. 5160-1-16 - Preventive services
  20. Sec. 5160-1-17 - Eligible providers
  21. Sec. 5160-1-17.1 - [Rescinded]Notification of rule and program changes
  22. Sec. 5160-1-17.2 - Provider agreement for providers
  23. Sec. 5160-1-17.3 - Provider disclosure requirements
  24. Sec. 5160-1-17.4 - Revalidation of provider agreements
  25. Sec. 5160-1-17.5 - Suspension of medicaid provider agreements
  26. Sec. 5160-1-17.6 - Termination and denial of provider agreement
  27. Sec. 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)]
  28. Sec. 5160-1-17.8 - Provider screening and application fee
  29. Sec. 5160-1-17.9 - Ordering or referring providers
  30. Sec. 5160-1-17.12 - Qualified entity requirements and responsibilities for determining presumptive eligibility
  31. Sec. 5160-1-18 - Telehealth
  32. APPENDIX to rule 5160-1-18 -
  33. Sec. 5160-1-19 - Claim submission
  34. Sec. 5160-1-19.1 - References to the "International Classification of Diseases (ICD)"
  35. Sec. 5160-1-19.9 - Inquiries regarding the status of claims [except for services provided through a medicaid managed care program]
  36. Sec. 5160-1-20 - Electronic data interchange (EDI) trading partner enrollment and testing
  37. Sec. 5160-1-23 - [Rescinded]Assignment of provider claims
  38. Sec. 5160-1-25 - Interest on overpayments made to medicaid providers
  39. Sec. 5160-1-27 - Review of provider records
  40. Sec. 5160-1-27.1 - Hold and review process
  41. Sec. 5160-1-27.2 - Medicaid hold and review process for medicaid claims paid through state agencies other than the Ohio department of medicaid
  42. Sec. 5160-1-29 - Medicaid fraud, waste, and abuse
  43. Sec. 5160-1-31 - Prior authorization [except for services provided through medicaid contracting managed care plans (MCPs)]
  44. Sec. 5160-1-32 - Medicaid: safeguarding and releasing information
  45. Sec. 5160-1-32.1 - Standard authorization form
  46. Sec. 5160-1-33 - Medicaid: authorized representatives
  47. Sec. 5160-1-39 - Verification of home care service provision to home care dependent adults
  48. Sec. 5160-1-40 - Electronic visit verification (EVV)
  49. Sec. 5160-1-57 - [Rescinded]Process for provider appeals from proposed departmental actions
  50. Sec. 5160-1-60 - Medicaid payment
  51. Sec. 5160-1-60.1 - [Rescinded]Special provisions for reimbursement for physician groups acting as outpatient hospital clinics
  52. Sec. 5160-1-60.2 - Direct reimbursement for out-of-pocket expense incurred for medicaid covered service
  53. Sec. 5160-1-60.3 - [Rescinded]
  54. Sec. 5160-1-60.4 - By-report procedures, services, and supplies
  55. Sec. 5160-1-61 - Non-covered services
  56. Sec. 5160-1-70 - Relocated provisions concerning episode based payments
  57. Sec. 5160-1-71 - Relocated provisions concerning patient centered medical homes (PCMH) and eligible providers
  58. Sec. 5160-1-72 - Relocated provisions concerning patient centered medical homes (PCMH) and payments
  59. Sec. 5160-1-73 - Behavioral health care coordination
  60. Sec. 5160-1-80 - Substitute practitioners (locum tenens)

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