Ohio Administrative Code Search

... can subject a continuing education provider or agent to administrative actions. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under sections 3901.041 and 3905.486 of the Revised Code. (C) Providers The following are violations of the pre-licensing education and continuing education statutes and rules: (1) Making any false, misleading, or de...

...-transferable (D) Continuing education provider and course initial and renewal application fees (1) Every continuing education provider shall pay the fee established in paragraph (D)(2) of this rule. The fee is due with the submission of the provider application. Course fees, where applicable, shall be submitted with the course application. (2) The applicant shall select one of the fee options listed below. If the...

...-transferable (D) Continuing education provider and course initial and renewal application fees (1) Every continuing education provider will pay the fee established in paragraph (D)(2) of this rule. The fee is due with the submission of the provider application. Course fees, where applicable, will be submitted with the course application. (2) The applicant will select one of the fee options...

...used in this rule: (1) "Authorized provider official" means a person designated by a provider and approved by the superintendent as the person who is responsible for a provider's compliance with the pre-licensing education regulations and who is responsible for a provider's integrity and operation. This includes the responsibility for obtaining pre-license education provider, course and instructo...

...used in this rule: (1) "Authorized provider official" means a person designated by a provider and approved by the superintendent as the person who is responsible for a provider's compliance with the pre-licensing education regulations and who is responsible for a provider's integrity and operation. This includes the responsibility for obtaining pre-license education provider, course and instructo...

...nt for a: (1) Licensed health care provider or a hospital registered with the Ohio department of health; (2) Federally qualified health center or a federally qualified health center look-alike as defined in section 3701.047 of the Revised Code; (3) Non-profit organization whose primary purpose is the distribution of food stuffs, groceries, donated goods or purchased goods in their community...

...nt for a: (1) Licensed health care provider or a hospital registered with the Ohio department of health; (2) Federally qualified health center or a federally qualified health center look-alike as defined in section 3701.047 of the Revised Code; (3) Non-profit organization whose primary purpose is the distribution of food stuffs, groceries, donated goods or purchased goods in their community...

...is rule. (5) "Continuing education provider" or "CE provider" means an individual or entity that is approved to offer continuing education courses pursuant to rule 3901-5-02 of the Administrative Code. (6) "FINRA" means the "Financial Industry Regulatory Authority" or a succeeding agency. (7) "Insurer" means a company, including a fraternal benefit society, required to be licensed under...

...owable expense. (d) Any expense that a provider by law or in accordance with a contractual agreement is prohibited from charging a covered person is not an allowable expense. (e) The definition of "allowable expense" may exclude certain types of coverage or benefits such as dental care, vision care, prescription drug or hearing aids. A plan that limits the application of "COB" to certain coverag...

...owable expense. (d) Any expense that a provider by law or in accordance with a contractual agreement is prohibited from charging a covered person is not an allowable expense. (e) The definition of "allowable expense" may exclude certain types of coverage or benefits such as dental care, vision care, prescription drug or hearing aids. A plan that limits the application of "COB" to certain coverag...

... from billed charges from a health care provider. (B) Authority This rule is issued pursuant to the authority vested in the superintendent of insurance under section 3901.041 of the Revised Code, general rule making authority; and sections 3901.19 to 3901.22 of the Revised Code, the unfair and deceptive acts statute. (C) Definitions (1) "Discount" means any negotiated reduction or variation from the schedule of b...

... from billed charges from a health care provider. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent of insurance under sections 3901.041 and 3901.19 to 3901.22 of the Revised Code. (C) Definitions (1) "Discount" means any negotiated reduction or variation from the schedule of billed charges (including capitation) that a health care provider otherwise wou...

...es its successors. (14) "Other provider" means a supplier of health care services or supplies not meeting the definition of health care practitioner or institutional care practitioner, including but not limited to a pharmacist, physician assistant, nurse aide, or supplier of durable medical equipment. (15) "Third-party payer" is as defined in section 3901.38 of the Revised Code. (D) Applica...

...clinical reviewer(s) or health care provider(s) do not have any prohibited affiliations as outlined in divisions (B) and (C)(1) of section 3922.14 of the Revised Code; (g) A description of the procedures to ensure that no conflict of interest exists in accordance with paragraph (G) of this rule; (h) A description of the quality assurance program as outlined in section 3922.14 of the Revised Code and...

...clinical reviewer(s) or health care provider(s) do not have any prohibited affiliations as outlined in divisions (B) and (C)(1) of section 3922.14 of the Revised Code. (g) A description of the procedures to ensure that no conflict of interest exists in accordance with paragraph (G) of this rule. (h) A description of the quality assurance program as outlined in section 3922.14 of the Revised Code and...

...nt-of-service option), plans offered by provider-sponsored organizations, and preferred provider organization plans; (b) Medical savings account plans coupled with a contribution into a "Medicare Advantage" medical savings account; and (c) "Medicare Advantage" private fee-for-service plans. (13) "Medicare supplement policy" means a group or individual policy of sickness and accident insurance o...

...nt-of-service option), plans offered by provider-sponsored organizations, and preferred provider organization plans; (b) Medical savings account plans coupled with a contribution into a "Medicare Advantage" medical savings account; and (c) "Medicare Advantage" private fee-for-service plans. (13) "Medicare supplement policy" means a group or individual policy of sickness and accident insurance o...

...amples include, but are not limited to, provider selection or referral, preadmission certification, length of stay determination and second surgical opinions. (3) "Day" means calendar day. However, when the last day of a time limit stated in this rule falls on a Saturday, Sunday or state or federal holiday, the time limit is extended to the next immediate following day that is not a Saturday, Sun...

...amples include, but are not limited to, provider selection or referral, preadmission certification, length of stay determination and second surgical opinions. (3) "Day" means calendar day. However, when the last day of a time limit stated in this rule falls on a Saturday, Sunday or state or federal holiday, the time limit is extended to the next immediate following day that is not a Saturday, Sun...

...amples include, but are not limited to, provider selection or referral, preadmission certification, length of stay determination and second surgical opinions. (3) "Day" means calendar day. However, when the last day of a time limit stated in this rule falls on a Saturday, Sunday or state or federal holiday, the time limit is extended to the next immediate following day that is not a Saturday, Sun...

...ations or restrictions on access to providers/facilities to enrollees and to potential enrollees prior to enrollment in a particular health plan. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code, general rule making authority; and section 3901.21 of the Revised Code, the unfair and deceptive acts statute. (C...

...ations or restrictions on access to providers/facilities to enrollees and to potential enrollees prior to enrollment in a particular health plan. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code, general rule making authority; and section 3901.21 of the Revised Code, the unfair and deceptive acts statute. (C...

... are provided by an out-of- network provider when either of the following conditions applies: (a) The covered person did not have the ability to request such services from an in-network provider. Clinical laboratory services provided by an out-of-network provider, but that are ordered by an in-network provider, shall be considered to have met the condition prescribed in paragraph (E)(7)(a) of ...

...tial licensure as a viatical settlement provider in this state or renewal of a previously-issued license. This rule also provides form filing requirements and fees for licenses, renewals, and form approvals. (B) Authority This rule is promulgated under the authority granted the superintendent of insurance pursuant to sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.05, and 3916.20 of the Revised Code. (C) Ap...

...rds and procedures and fees for VSE providers, VSE courses and licensed viatical settlement brokers pursuant to Chapter 3916. of the Revised Code. (B) Authority This rule is issued pursuant to the authority vested in the superintendent under sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.03, and 3916.20 of the Revised Code. (C) Application and scope This rule applies to all persons applying...