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Medicaid/CHIP Data Requirements in Ohio

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Ohio has implemented laws governing the Medicaid program in the state to ensure that the program operates effectively.  The department of job and family services must annually report to both houses of the state legislature information on the effectiveness of the medical assistance program in meeting the needs of low-income pregnant women, infants, and children, which will include a report on birth outcomes and the number of visits by eligible participants.1  Information about individuals participating in the medical assistance program is confidential, and may only be disclosed for purposes directly related to administration of the Medicaid program or as otherwise permitted by law.2

Medicaid providers must agree to maintain all necessary records for six years from the date of receipt of payment or until completion of an audit; providers must also agree to furnish any information maintained in these records for audit and review purposes to appropriate authorities and comply with relevant confidentiality safeguards.3 Nursing facilities and intermediate care facilities for the mentally retarded participating in the Medicaid program must annually submit cost reports, and must retain all records necessary to support such reports for seven years after the report is filed, or for six years after all appeal rights relating to an audit are exhausted, if the department of job and family services issues an audit report.4

Medicaid managed health care programs must retain and safeguard by the program and its subcontractors for six years from the renewal, amendment or termination date of the provider agreement.5  Managed health care programs must keep detailed records for each hospital with which it contracts about the utilization of services by Medicaid participants, and payments made by the organization to the hospital for the services.6

 

Footnotes

  • 1. Ohio Rev. Code § 5111.09
  • 2. Ohio Admin. Code 5101:1-37-01.1
  • 3. Ohio Admin. Code 5101:3-1-17.2
  • 4. Ohio Admin. Code 5101:3-3-20
  • 5. Ohio Admin. Code 5101:3-26-06
  • 6. Ohio Rev. Code § 5111.175

 

Medicaid/CHIP Data Requirements in Ohio

Subtopic Statute/Regulation Description
Mandatory reporting by Medicaid providers (cost/utilization information) Annual cost report – Ohio Rev. Code Ann. § 5165.10 Each provider must annually file with the department of job and family services a cost report for each of the provider’s nursing facilities and...
Nursing facilities (NFs): Medicaid cost report filing, record retention, and disclosure requirements – Ohio Admin. Code 5160-3-20 Each nursing facility and intermediate care facility for the mentally retarded participating in the Medicaid program must electronically file an...
Medicaid/CHIP Data Requirements Annual report – Ohio Rev. Code Ann. § 5162.13 The department of job and family services must submit to both houses of the state legislature, and make available to the public, a report on the...
Records for determining costs – Ohio Rev. Code Ann. § 5167.26 Managed care organizations under contract with the department to provide, or arrange for the provision of, hospital services to Medicaid recipients...
Third-party cooperation regarding liability information – Ohio Rev. Code Ann. § 5160.39 A third party must cooperate with the department of job and family services in identifying individuals for whom the third party is liable for payment...
Quality reporting by Medicaid providers (cross post to care coordination/care management (chronic disease management; sharing information across providers; enrollee participation) Assessment to determine level of care – Ohio Rev. Code Ann. § 5165.04 “Assessment to determine level of care”   The department of job and family services may require each applicant for or recipient of...
Managed care performance payment system - Ohio Rev. Code Ann. § 5167.30 The department of job and family services must establish a managed care performance payment program, which will include performance standards based...
Brief description of each state’s Medicaid program (Name and unique characteristics) Care management system – Ohio Rev. Code Ann. § 5167.03 The department of job and family services will establish a care management system as part of the Medicaid program.  The department may require...
Confidentiality of Medicaid data (including penalties for violating confidentiality) Confidentiality – Ohio Rev. Code Ann. § 5165.88 The department of job and family services and any contracting agency must protect the identity of nursing facility residents and any individual who...
Access to Medicaid data (by patients, providers, and government agencies) Disclosure of medical assistance information – Ohio Rev. Code Ann. § 5160.45 Information regarding a medical assistance recipient may only be disclosed in connection with the administration of the medical assistance program....
Click on the individual state law in the table above to see our summary of the individual law.


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