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Ohio MedicaidMedicaid · Reimbursement · Reimbursement · OHMedium impact

5160-1-05.3 - Payment for "Medicare Part B" cost sharing. (Amend/Revise)

Effective date
Nov 2, 2026
Identified
Nov 7, 2026

Previous versions

Summary

Ohio Department of Medicaid filed a revised version (Amendment, effective 11/02/2026 per the filing record) of rule 5160-1-05.3, which governs payment for Medicare Part B cost sharing. The filing record shows the revision was filed 11/06/2026; the excerpt does not provide the substantive payment text, so the specific changes to cost-sharing payment cannot be identified from it.

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What to do

Action · 2 steps
01Already effective 11/02/2026: Billing team should pull the current text of rule 5160-1-05.3 from the Ohio Register and confirm how Medicaid cost-sharing payments for Medicare Part B coinsurance and deductibles are now applied to claims for dual-eligible patients.
02Update charge entry and claim edits for those patients so Medicare crossover claims and secondary Medicaid billing reflect the revised payment rules, and brief front desk staff on any patient cost-sharing collection changes.

Original notice

5160-1-05.3 - Payment for "Medicare Part B" cost sharing. (Amend/Revise)
registerofohio.state.oh.us · Always check the source before changing claims.
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