Ohio Admin. Code 5160-1-61 - Non-covered services
(1) A service that is specified in a
rule in agency 5160 of the Administrative Code as non-covered or excluded from
payment;
(3) A service that is performed for
purposes of research or clinical trial;
(9) Plastic or cosmetic surgery
performed solely for aesthetic purposes;
(10) Biofeedback;
(B) Nothing in this rule precludes
payment for a service that meets all of the following criteria:
(1) The service is medically
necessary;
(2) The service is not
experimental;
(3) The service is provided to an
individual who has received another service that is experimental in nature or
that is performed for purposes of research or clinical trial;
and
(4) The need for the
non-experimental service did not arise solely because the individual received
an experimental service or participated in research or a clinical
trial.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 12/21/1977, 12/30/1977, 07/01/1980, 10/01/1987, 09/01/1989, 04/01/1992 (Emer.), 07/01/1992, 07/01/1993, 01/04/2000 (Emer.), 03/20/2000, 12/31/2001 (Emer.), 03/09/2002, 12/30/2005 (Emer.), 03/27/2006, 11/13/2006, 07/01/2009, 07/01/2016, 01/01/2017
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) A service that is specified in a rule in agency 5160 of the Administrative Code as non-covered or excluded from payment;
(3) A service that is performed for purposes of research or clinical trial;
(9) Plastic or cosmetic surgery performed solely for aesthetic purposes;
(10) Biofeedback;
(B) Nothing in this rule precludes payment for a service that meets all of the following criteria:
(1) The service is medically necessary;
(2) The service is not experimental;
(3) The service is provided to an individual who has received another service that is experimental in nature or that is performed for purposes of research or clinical trial; and
(4) The need for the non-experimental service did not arise solely because the individual received an experimental service or participated in research or a clinical trial.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 12/21/1977, 12/30/1977, 07/01/1980, 10/01/1987, 09/01/1989, 04/01/1992 (Emer.), 07/01/1992, 07/01/1993, 01/04/2000 (Emer.), 03/20/2000, 12/31/2001 (Emer.), 03/09/2002, 12/30/2005 (Emer.), 03/27/2006, 11/13/2006, 07/01/2009, 07/01/2016, 01/01/2017