Ohio Revised Code Search

...on committee of a hospital or long-term care facility or of any not-for-profit health care corporation that is a member of the hospital or long-term care facility or of which the hospital or long-term care facility is a member are confidential and shall be used by the committee and the committee members only in the exercise of the proper functions of the committee. Any information, data, reports, or records made a...

...o be admitted to a long-term acute care hospital or rehabilitation hospital if not for nursing facility services, and other serious health care conditions; (3) For each fiscal year, set the total per medicaid day payment rate for nursing facility services provided by designated discrete units of nursing facilities under the alternative purchasing model at either of the following: (a) Thirty-four per cent of the...

...ll nursing homes and hospital long-term care units for the fiscal year; (2) Multiply the estimated total net patient revenues determined under division (A)(1) of this section by the lesser of the following: (a) The indirect guarantee percentage; (b) Six per cent. (3) Divide the product determined under division (A)(2) of this section by the number of days in the fiscal year; (4) Determine the sum of the foll...

...led nursing facility beds or long-term care beds, plus any other beds licensed as nursing home beds under section 3721.02 or 3721.09 of the Revised Code, on the first day of May of the calendar year in which the fee is determined pursuant to division (A) of section 5168.47 of the Revised Code; (2) The number of days in the fiscal year beginning on the first day of July of the calendar year in which the fee is ...

... review committee of a hospital or long-term care facility or a peer review committee of a nonprofit health care corporation that is a member of the hospital or long-term care facility or of which the hospital or facility is a member; (b) A peer review committee of a community mental health center; (c) A board or committee of a hospital, a long-term care facility, or other health care entity when reviewing pro...

...d to, any medical or dental, office, or hospital communication such as a record, chart, letter, memorandum, laboratory test and results, x-ray, photograph, financial statement, diagnosis, or prognosis. (b) As used in division (B)(2) of this section, "health care provider" means a hospital, ambulatory care facility, long-term care facility, pharmacy, emergency facility, or health care practitioner. (c) As used in ...

...n-basic, emergency medical technician-intermediate, or emergency medical technician-paramedic certified under Chapter 4765. of the Revised Code ; (s) A certified mental health assistant licensed under Chapter 4772. of the Revised Code. (5) "Health care provider" means a hospital, ambulatory care facility, long-term care facility, pharmacy, emergency facility, or health care practitioner. (6) "Hospital" has the ...

...ended, including a long-term acute care hospital that provides medical and rehabilitative care to patients who require an average length of stay greater than twenty-five days and is classified by the centers for medicare and medicaid services as a long-term care hospital pursuant to 42 C.F.R. 412.23(e); (c) A county home or district home operated pursuant to Chapter 5155. of the Revised Code; (d) A residential faci...

...nded, including a long-term acute care hospital that provides medical and rehabilitative care to patients who require an average length of stay greater than twenty-five days and is classified by the centers for medicare and medicaid services as a long-term care hospital pursuant to 42 C.F.R. 412.23(e); (3) County homes and district homes operated pursuant to Chapter 5155. of the Revised Code; (4) Residential ...

...ing other than an acute care unit of a hospital. "Long-term care insurance" includes group and individual annuities and life insurance policies or riders that provide directly or supplement long-term care benefits, and policies or riders that provide for payment of benefits based on cognitive impairment or the loss of functional capacity. "Long-term care insurance" includes group and individual policies or ride...

...illed nursing facility bed or long-term care bed in a manner that reduces the total number of hospital beds registered under that section as skilled nursing facility beds or long-term care beds and makes it impossible for the bed to ever be registered as a skilled nursing facility bed or long-term care bed. (B) "Change of operator" has the same meaning as in section 5165.01 of the Revised Code. (C) "Effective d...

...he Revised Code, or hospital long-term care unit as defined in section 5168.40 of the Revised Code. For purposes of division (A)(7) of this section, a decedent's last continuous stay includes up to thirty consecutive days during which the decedent was temporarily absent from the nursing home, residential facility, or hospital long-term care unit. (8) Personal property taxes, claims made under the medicaid est...

...age, the individual received inpatient hospital services for at least fourteen consecutive days, or had at least three inpatient hospital stays during the twelve months, immediately preceding the date the individual applies for the Ohio home care waiver program. (2) If the individual is at least twenty-one but less than sixty years of age, the individual received inpatient hospital services for at least fourte...

...m. (E) "Health benefit plan" means any hospital or medical expense policy of insurance or a health care plan provided by an insurer, including a health insuring corporation plan, provided by or through an insurer, or any combination thereof. "Health benefit plan" does not include any of the following: (1) A policy covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicar...

...t, dental, disability income, long-term care, hospital indemnity, medicare supplement, specified disease, or vision care; coverage under a one-time-limited-duration policy that is less than twelve months; coverage issued as a supplement to liability insurance; insurance arising out of a workers' compensation or similar law; automobile medical-payment insurance; or insurance under which benefits are payable with or wi...

...ment, accident-only, specified disease, hospital indemnity, disability income, long-term care, or other limited benefit hospital insurance policies. Except as otherwise provided in division (B) of this section, coverage under this section shall not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an enrollee than the dollar limits, deductibles, or coinsurance provisions t...

...ment, accident-only, specified disease, hospital indemnity, disability income, long-term care, or other limited benefit hospital insurance policies. Except as otherwise provided in division (B) of this section, coverage under this section shall not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions th...

...1396, as amended; (3) An increase of hospital beds reported in an application submitted under section 3722.03 of the Revised Code as long-term care beds. (B) For the purpose of implementing this section, the director shall do all of the following: (1) Not later than October 1, 2023, and every two years thereafter, determine the long-term care bed supply for each county, which shall consist of all of the foll...

...t not limited to, coverage of inpatient hospital services, outpatient services, and medication; maximum lifetime benefits; copayments; and individual and family deductibles. (D) This section does not apply to a plan of health coverage if federal law supersedes, preempts, prohibits, or otherwise precludes its application to such plans. This section does not apply to long-term care, hospital indemnity, disability...

...es, or a health care setting, including hospitals and other licensed inpatient centers, ambulatory, surgical, treatment, skilled nursing, residential treatment, diagnostic, laboratory, and imaging centers, and rehabilitation and other therapeutic health settings. (K) "Final adverse benefit determination" means an adverse benefit determination that is upheld at the completion of a health plan issuer's internal ...

...ut excludes any hospital indemnity, medicare supplement, long-term care, disability income, one-time-limited-duration policy that is less than twelve months, supplemental benefit, or other policy that provides coverage for specific diseases or accidents only; any policy that provides coverage for workers' compensation claims compensable pursuant to Chapters 4121. and 4123. of the Revised Code; and any policy that pro...

...tal, disability income, long-term care, hospital indemnity, supplemental coverage as described in section 3923.37 of the Revised Code, specified disease, or vision care; a dental benefit that is offered as a part of a policy, contract, certificate, or agreement offered by a health insuring corporation; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar la...

...tal, disability income, long-term care, hospital indemnity, supplemental coverage as described in section 3923.37 of the Revised Code, specified disease, or vision care; a dental benefit that is offered as a part of a policy of sickness and accident insurance or a public employee benefit plan; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar law; automo...

...dit, disability income, long-term care, hospital indemnity, medicare supplement, or specified disease; coverage under a one-time-limited-duration policy that is less than twelve months; coverage issued as a supplement to liability insurance; insurance arising out of a workers' compensation or similar law; automobile medical-payment insurance; or insurance under which benefits are payable with or without regard to fau...

...tal, disability income, long-term care, hospital indemnity, medicare supplement, medicare, tricare, specified disease, or vision care; coverage under a one-time-limited-duration policy that is less than twelve months; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar law; automobile medical payment insurance; or insurance under which benefits are payable...