5160-1-05.3 Payment for "Medicare Part B" cost sharing.

 

 

 

LEGAL NOTICE STATE OF OHIO

OHIO DEPARTMENT OF MEDICAID COLUMBUS, OHIO

 

DATE:                         November 16th, 2015

TIME:                        11:00am

LOCATION:             Room A501, Ohio Department of Medicaid, Lazarus Building 50 West Town Street, 5th Floor, Columbus, Ohio 43215

 

Pursuant to section 5164.02 of the Ohio Revised Code (ORC), Chapter 119 of the ORC, and 42 CFR 447.205, the director of the Department of Medicaid gives notice of the department's intent to consider the adoption of the rule identified below and of a public hearing thereon.

 

Rule 5160-1-05.3, Payment for Medicare Part B cost sharing which provides the payment methodology for Medicare Part B crossover claims, is being amended as Ohio exercises its authority under federal law (§1902(n)(2) of the Social Security Act) to not pay more than the Medicaid primary payer amount for Medicare Part B crossover claims. Currently, individual providers, including physicians, dentists, optometrists, podiatrists, chiropractors, nurse practitioners and certified-registered nurse anesthetists (CRNAs), are exempt from this payment methodology.  As a result of the proposed amendment, they will now be subject to it.  This change is necessary because it contributed to building the Department's appropriations established in Am. Sub. H.B. 64 of the 131st General Assembly.

 

The Department estimates that these changes will result in  a decrease in expenditures of

$86.2 million on an annual aggregate basis.

 

A public hearing on the proposed rule will be held at the date, time, and location listed at the top of this notice. Either written or oral testimony will be taken at the public hearing. Additionally, written comments submitted or postmarked no later than the date of the public hearing will be treated as testimony. A copy of the proposed rule is available, without charge, to any person affected by the rule at the address listed below. The rule is also available on the internet at http://www.registerofohio.state.oh.us/. In addition, a copy of the proposed rules are available for public review at each County Department of Job and Family Services.

 

 

 

Requests for a copy of the proposed rule and testimony on the rule should be submitted by mail to the Ohio Department of Medicaid Rule Administrator, Office of Legal Counsel, 50 West Town Street, 4th Floor, Columbus, Ohio 43215-3414, by fax at [phone], or by e-mail at [e-mail]. Testimony received may be reviewed at this address.