Medicare AdvantageReimbursementMedium impact
5160-1-05.1 - Payment for "Medicare Part C" cost sharing. (Rescind/Final File)
Ohio Medicaid·OH·Reimbursement
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has rescinded and refiled Rule 5160-1-05.1 regarding payment for Medicare Part C (Medicare Advantage) cost sharing requirements. This represents a complete replacement of the previous rule governing how Medicaid coordinates with Medicare Advantage plans for member cost sharing.
Action Required
By July 1, 2023: Ohio providers serving dual-eligible patients must review updated Medicaid coordination of benefits procedures for Medicare Advantage members. Billing team should verify current cost sharing protocols in billing system and confirm proper secondary billing procedures for Medicaid when Medicare Advantage is primary. Contact Ohio Medicaid at 614-752-3877 for specific implementation guidance.