Ohio Code 5167.201 – Payment of nonsystem provider for emergency services
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When a medicaid managed care organization‘s enrollee receives emergency services on or after January 1, 2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the amounts (less any payments for indirect costs of medical education and direct costs of graduate medical education) that the provider could collect if the enrollee received medicaid other than through enrollment in a medicaid MCO plan.
Terms Used In Ohio Code 5167.201
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: means a medicaid recipient who participates in the care management system and enrolls in a medicaid MCO plan. See Ohio Code 5167.01
- Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
- Medicaid managed care organization: means a managed care organization under contract with the department of medicaid pursuant to section 5167. See Ohio Code 5167.01
- Provider: means any person or government entity that furnishes services to a medicaid recipient enrolled in a medicaid MCO plan, regardless of whether the person or entity has a provider agreement. See Ohio Code 5167.01
An agreement entered into by an enrollee, an enrollee’s parent, or an enrollee’s legal guardian that requires payment for emergency services in violation of this section is void and unenforceable.