Ohio Medicaid Sample Clauses

Ohio Medicaid. The Ohio Department of Medicaid (ODM), the agency responsible for administering the Medicaid program in the state of Ohio.
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Ohio Medicaid. The Office of Medical Assistance (OMA), the agency responsible for administering the Medicaid program in the state of Ohio. Ohio Revised Code (ORC)—Contains all Ohio statutes of a general and permanent nature passed by the Ohio General Assembly and signed by the governor. Opt Out – A process by which a beneficiary can choose not to participate in the Demonstration and receive their Medicare benefits through Fee for Service (FFS) Medicare and a standalone Part D Plan; Program of All-inclusive Care for the Elderly (PACE); or Medicare Advantage. Passive Enrollment - The process through which an eligible individual is enrolled in an ICDS Plan, when not otherwise affirmatively electing one, following a minimum 60-day notice prior to the effective date. Privacy - Requirements established in the Health Insurance Portability and Accountability Act of 1996, and implementing regulations, Medicaid regulations, including 42 CFR 431.300 through 431.307, as well as relevant Ohio privacy laws. Quality Improvement Organization (QIO) – A statewide organization that contracts with CMS to evaluate the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries. Readiness Review - Prior to entering into a three way agreement with the State and CMS, each ICDS Plan selected to participate in the Demonstration will undergo a readiness review. The readiness review will evaluate each ICDS Plan’s ability to comply with the Demonstration requirements, including but not limited to, the ability to quickly and accurately process claims and enrollment information, accept and transition new members, and provide adequate access to all Medicare- and Medicaid‐covered medically necessary services. CMS and the State will use the results to inform their decision of whether the ICDS Plan is ready to participate in the Demonstration. At a minimum, each readiness review will include a desk review and potentially a site visit to the ICDS Plan’s headquarters. Solvency - Standards for requirements on cash flow, net worth, cash reserves, working capital requirements, insolvency protection and reserves established by the State and agreed to by CMS. State - The State of Ohio. Trans-disciplinary care management team – A team of appropriately qualified professionals comprised of the Enrollee, the Enrollee’s family/caregiver, the ICDS Plan care manager, the waiver service coordinator, if appropriate, the primary care provider, specialists, and other providers, as applicable, tha...
Sample 1

Related to Ohio Medicaid

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S RESOURCES. Services reimbursed under Medicaid are outlined in Attachment “A” to this Agreement. Once a Medicaid application has been submitted on the Resident’s behalf, the Resident, Sponsor, and Resident Representative agree to pay, to the extent they have access to the Resident’s funds, to the Facility the Resident’s monthly income, which will be owed to the Facility under the Resident’s Medicaid budget. Medicaid recipients are required to pay their Net Available Monthly Income (“NAMI”) to the Facility on a monthly basis as a co-payment obligation as part of the Medicaid rate. A Resident’s NAMI equals his or her income (e.g., Social Security, pension, etc.), less allowed deductions. The Facility has no control over the determination of NAMI amounts, and it is the obligation of the Resident, Resident Representative and/or Sponsor to appeal any disputed NAMI calculation with the appropriate government agency. Once Medicaid eligibility is established, the Resident, Resident Representative and/or Sponsor agree to pay NAMI to the Facility or to arrange to have the income redirected by direct deposit to the Facility and to ensure timely Medicaid recertification. The Resident, Sponsor and Resident Representative agree to provide to the Facility copies of any notices (such as requests for information, budget letters, recertification, denials, etc.) they receive from the Department of Social Services related to the Resident’s Medicaid coverage. Until Medicaid is approved, the Facility may bill the Resident’s account as private pay and the Resident will be responsible for the Facility’s private pay rate. If Medicaid denies coverage, the Resident or the Resident’s authorized representative can appeal such denial; however, payment for any uncovered services will be owed to the Facility at the private pay rate pending the appeal determination. If Medicaid eligibility is established and retroactively covers any period for which private payment has been made, the Facility agrees to refund or credit any amount in excess of the NAMI owed during the covered period.

  • Child Care A. Employees employed as of March 1 who meet the following criteria shall be eligible for a lump sum payment each year. Eligible employees may apply for this payment between March 1 and April 15 of each year. Payment shall be made within thirty (30) days of receipt of the completed application. Any application received after April 15 will be considered on a case by case basis and shall not be arbitrarily rejected.

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