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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) "Acquisition of a new computer system" means the purchase of a "computer system," as defined in this rule, that is not a computer system currently in place nor one for which the acquisition process has been initiated as of April 7, 2009.

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(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.

"Employee of the state agency" is limited to the specific employing state agency.