Section 5164.75 | Medicaid Payment for a Drug Subject to a Federal Upper Reimbursement Limit.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly As used in this section, “federal upper reimbursement limit” means the limit established pursuant to the “Social Security Act,” section 1927(e), 42 U.S.C. 1396r-8(e). The medicaid payment for a drug that is subject to a federal upper reimbursement limit shall not exceed, […]
Section 5164.751 | State Maximum Allowable Cost Program.
Effective: April 12, 2021 Latest Legislation: Senate Bill 263 – 133rd General Assembly (A) As used in this section, “state maximum allowable cost” means the per unit amount the medicaid program pays a terminal distributor of dangerous drugs for a prescribed drug included in the state maximum allowable cost program established under division (B) of […]
Section 5164.752 | Determining Maximum Dispensing Fee.
Effective: September 29, 2017 Latest Legislation: House Bill 49 – 132nd General Assembly In July of every even-numbered year, the department of medicaid shall initiate a confidential survey of the cost of dispensing drugs incurred by terminal distributors of dangerous drugs in this state. The survey shall be used as the basis for establishing the […]
Section 5164.753 | Dispensing Fee.
Effective: September 29, 2017 Latest Legislation: House Bill 49 – 132nd General Assembly In December of every even-numbered year, the medicaid director shall establish dispensing fees, effective the following July, for terminal distributors of dangerous drugs that are providers of drugs under the medicaid program. In establishing dispensing fees, the director shall take into consideration […]
Section 5164.754 | Agreement for Multiple-State Drug Purchasing Program.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly (A) As used in this section, “dangerous drug” and “manufacturer of dangerous drugs” have the same meaning as in section 4729.01 of the Revised Code. (B) The medicaid director may enter into or administer an agreement or cooperative arrangement with other states […]
Section 5164.755 | Supplemental Drug Rebate Program.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly The medicaid director, in rules adopted under section 5164.02 of the Revised Code, may establish and implement a supplemental drug rebate program under which drug manufacturers may be required to provide the department of medicaid a supplemental rebate as a condition of […]
Section 5164.756 | Drug Rebate Agreement or Supplemental Drug Rebate Agreement for Medicaid Program Not Subject to Public Records Law.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly Any record, data, pricing information, or other information regarding a drug rebate agreement or a supplemental drug rebate agreement for the medicaid program that the department of medicaid receives from a pharmaceutical manufacturer or creates pursuant to negotiation of the agreement is […]
Section 5164.721 | Claims by Freestanding Birthing Centers.
Effective: April 6, 2017 Latest Legislation: Senate Bill 332 – 131st General Assembly A hospital or freestanding birthing center that is a medicaid provider may submit to the department of medicaid or the department’s fiscal agent a medicaid claim that is both of the following: (A) For a long-acting reversible contraceptive device that is covered […]
Section 5164.56 | Lien for Amount Owed by Provider.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly Under the medicaid program, any amount determined to be owed the state by a final fiscal audit conducted pursuant to section 5164.55 of the Revised Code, upon the issuance of an adjudication order pursuant to Chapter 119. of the Revised Code that […]
Section 5164.57 | Recovery of Medicaid Overpayments.
Effective: September 29, 2015 Latest Legislation: House Bill 64 – 131st General Assembly (A)(1) Except as provided in division (A)(2) of this section, the department of medicaid may recover a medicaid payment or portion of a payment made to a medicaid provider to which the provider is not entitled if the department notifies the provider […]