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Due to heightened security alerts near the state capitol, OHCA will cancel the Jan. 20, 2021 board meeting and reschedule for next week. The safety of OHCA employees, board members and partners is of paramount importance. Once confirmed, the new date and time will be posted here.


1.0 – Single State Agency Organization 

        • 1.1 – Designation and Authority

        • 1.2 – Organization for Administration 

        • 1.3 – Statewide Operation

        • 1.4 – State Medical Care Advisory Committee 

        • 1.5 – Pediatric Immunization Program 


Medicaid Eligibility


2.0 Coverage and Eligibility

2.1 Application, Determination of Eligibility and Furnishing Medicaid 

2.2 Coverage and Conditions of Eligibility 

2.4 Blindness 

2.5 Disability

2.6 Financial Eligibility

2.7 Medicaid Furnished Out of State 

3.1 Amount, Duration, and Scope of Services 

3.2 Coordination of Medicaid with Medicare Part B

3.3 Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases 

3.4 Special Requirements Applicable to Sterilization Procedures 

3.5 Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries 

                 3.8 Additional Amounts for Nursing Facility Residents

3.6 Ambulatory Prenatal Care for Pregnant Women during Presumptive Eligibility Period 

4.1 Methods of Administration 

4.2 Hearings for Applicants and Recipients

4.3 Safeguarding Information on Applicants and Recipients 

4.4 Medicaid Quality Control 

4.5 Medicaid Agency Fraud Detection and Investigation Program 

·Attachment A – General Program Administration  

4.6 Reports 

4.7 Maintenance of Reports 

4.8 Availability of Agency Program Manuals 

4.9 Reporting Provider Payments to the Internal Revenue Service

4.10 Free Choice of Providers 

4.11 Standards for Institutions 

·Attachment A – Standards for Institutions

4.12 Consultation to Medical Facilities 

4.13 Required Provider Agreement

4.14 Utilization/Quality Control 

4.15 Inspections of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases 

4.16 Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees

4.17 Liens and Recoveries – Long Term Care Insurance Partnership 

4.18 Cost Sharing and Similar Charges 

4.19 Payment for Services 

4.20 Direct Payments to Certain Recipients for Physicians; or Dentists’ Services 

4.21 Prohibition Against Reassignment of Provider Claims 

4.22 Third Party Liability 

4.23 Use of Contracts 

4.24 Standards for Payments for Nursing Facility and Intermediate Care Facility for the Mentally Retarded Services  

4.25 Program for Licensing Administrators of Nursing Homes

4.26 Drug Utilization Review Program 

4.27 Disclosure of Survey Information and Provider or Contractor Evaluation 

4.28 Appeals Process for Skilled Nursing and Intermediate Care Facilities

4.29 Conflict of Interest Provisions 

4.30 Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals 

·Attachment to 4.30 – Sanctions for MCOs and PCCMs

4.31 Disclosure of Information by Providers and Fiscal Agents 

4.32 Income and Eligibility Verification System 

4.33 Medicaid Eligibility Cards for Homeless Individuals 

4.34 Systematic Alien Verification for Entitlements 

4.35 Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation 

4.36 Required Coordination Between the Medicaid and WIC Programs 

4.38 Nurse Aide Training and Competency Evaluation for Nursing Facilities 

4.39 Preadmission Screening and Annual Resident Review in Nursing Facilities 

·Attachment A – Categorical Determinations  

4.43 Cooperation with Medicaid Integrity Program Efforts  

5.1 Standards of Personnel Administration 

                 5.2 [Reserved]


                 5.3 Training Programs; Subprofessional and Volunteer Programs 

6.1 Fiscal Policies and Accountability 

6.2 Cost Allocation

6.3 State Financial Participation 

7.1 Plan Amendments 

7.2 Nondiscrimination  

7.3 Maintenance of AFDS Effort  

7.4 State Governor's Review

                 7.4 Medicaid Disaster Relief for the COVID-19 National Emergency


Last Modified on Jan 13, 2021
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