5160-2-04. Coverage of hospital-provided pharmaceutical, dental, vision care, medical supply and equipment, and medically-related transportation services

(A) Drugs.

(1) Drugs are classified as: administered inpatient (drugs administered to a patient while an inpatient); administered outpatient (drugs administered to a patient at the hospital in connection with outpatient services); take-home (drugs dispensed on an outpatient basis for use away from the hospital).

(2) Administered inpatient drugs are considered inpatient services and are reimbursed as an inpatient service. Administered outpatient drugs are considered outpatient services and are reimbursed as an outpatient hospital service in accordance with rule 5160-2-21 of the Administrative Code. Take-home drugs must be billed in accordance with provisions in Chapter 5160-9 of the Administrative Code. Payment to hospitals for take-home drugs will be reimbursed according to the provisions of Chapter 5160-9 of the Administrative Code.

(B) Medical supplies and equipment.

(1) Inpatient coverage:

(a) Supplies and equipment are covered for the care and treatment of the recipient during an inpatient stay and include:

(i) Implants and devices that are part of a surgical, immediate post surgical, or early fitting procedure (e.g., pacemakers, halos, and prosthetic devices);

(ii) Appliances that are generally applied prior to discharge (e.g., initial prostheses); and

(iii) Other items that are medically necessary as described in rule 5160-1-01 of the Administrative Code to permit or facilitate the patient's discharge from the hospital until such time as the recipient can obtain a permanent item or supply.

(b) Covered items must be included in the hospital's inpatient billing.

(c) Medical supplies and equipment provided to medicaid recipient for use outside the hospital are reimbursed accordance with Chapter 5160-10 of the Administrative Code.

(2) Outpatient coverage:

(a) Chapter 5160-10the Administrative Code describes the coverage and reimbursement of medical supplies provided during the provision of an outpatient visit

(b) Medical supplies and equipment provided to the medicaid recipient for use outside the hospital are reimbursed in accordance with Chapter 5160-10 of the Administrative Code.

(C) Dental services: Except for dental services described in rule 5160-2-03 of the Administrative Code and emergency dental services provided in the emergency room, all dental services are covered and reimbursed as dental services under the provisions set forth in Chapter 5160-5 of the Administrative Code.

(D) Vision care services: All vision care services are covered and reimbursed as inpatient or outpatient hospital services. All vision care materials are covered and reimbursed in accordance with the provisions of Chapter 5160-6 of the Administrative Code.

(E) Medically-related transportation services: The services of hospital staff as attendants during transportation are covered and reimbursed as an inpatient or outpatient hospital service. Transportation to or from a hospital, including inter hospital transfer, that is provided in accordance with Chapter 5160-15 of the Administrative Code is not a hospital service and is reimbursed as described in Chapter 5160-15 of the Administrative Code. .

Effective: 4/30/2015
Five Year Review (FYR) Dates: 01/14/2015 and 04/30/2020
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5164.02
Prior Effective Dates: 4/7/77, 12/21/77, 12/30/77, 1/8/79, 2/1/80, 10/1/83 (Emer), 12/29/83, 10/1/84, 9/3/91 (Emer), 11/10/91, 8/1/02 , 11/01/07