Ohio Revised Code Search

...ceived from the covered person, to the health plan issuer. Upon receipt of that information or the information described in division (K) of section 3922.10 of the Revised Code, a health plan issuer may reconsider its adverse benefit determination and provide coverage for the health service in question. Reconsideration of an adverse benefit determination by a health plan issuer based upon receipt of informatio...

...n's medical records; (B) The attending health care professional's recommendation; (C) Consulting reports from appropriate health care professionals and other documents submitted by the health plan issuer, covered person, or covered person's treating provider; (D) The terms of coverage under the covered person's health benefit plan to ensure that the independent review organization's decision is not contrary to...

... review that is complete and valid, the health plan issuer shall provide to the assigned independent review organization all documents and information considered in making the adverse benefit determination. (C) An external review shall not be delayed due to failure on the part of the health plan issuer to provide the information required under division (B) of this section. (D)(1) An independent review organiza...

...ted by the United States department of health and human services under 42 U.S.C. 1395x(t)(2), as amended, or in medical literature that meets the criteria specified in division (B) of this section. (B) Medical literature may be accepted for purposes of division (A) of this section only if all of the following apply: (1) Two articles from major peer-reviewed professional medical journals have recognized, based...

... publication of the American society of health system pharmacists; (c) "Drug information for the health care provider," a publication of the United States pharmacopeia convention. (2) Medical literature may be accepted for purposes of division (A) of this section only if all of the following apply: (a) Two articles from major peer-reviewed professional medical journals have recognized, based on scientific or medic...

...erwise provided in section 2721 of the "Health Insurance Portability and Accountability Act of 1996," Pub. L. No. 104-191, 110 Stat. 1955, 42 U.S.C.A. 300gg-21, as amended, health benefit plans covering small employers are subject to the following conditions, as applicable: (A)(1) Pre-existing conditions provisions shall not exclude or limit coverage for a period beyond twelve months, or eighteen months in the case ...

...)(2) of this section, the Ohio life and health insurance guaranty association may do either of the following with respect to an impaired member insurer: (a) Guarantee, assume, reissue, or reinsure, or cause to be guaranteed, assumed, reissued, or reinsured, any or all of the policies or contracts of the impaired insurer; (b) Provide the moneys, pledges, notes, guarantees, or other means that are proper to effec...

...ields of education, employment, energy, health, housing, welfare, and recreation; (G) Propose new programs concerning sub-Saharan African people to public and private agencies and evaluate for such agencies existing programs or prospective legislation concerning sub-Saharan African people; (H) Review and approve grants to be made from federal, state, or private funds that are administered or subcontracted by the ...

...s governing authority can make informed decisions. (8) Wide variety of software programs which translate medical terminology into standard codes, and which reveal if a provider is manipulating the procedures codes, commonly called "unbundling." (9) Necessary professional staff to conduct, at a minimum, authorizations for treatment, medical necessity, utilization review, concurrent review, post-utilization review, a...

... a Background Check in making licensure decisions; 6. Have Continuing Competence requirements as a condition for license renewal; 7. Participate in the Data System, including through the use of unique identifying numbers as described herein; 8. Notify the Commission and other Member States, in compliance with the terms of the Compact and Rules of the Commission, of any disciplinary action taken by the State aga...

...n a patient's decision-making regarding health care services, including a patient's spouse or partner, parents, children, siblings, or guardians. An individual's status as a key third party ceases upon termination of a practitioner-patient relationship or termination of the relationship between a patient and the individual. (2) "Practitioner" means any of the following: (a) An individual authorized under this cha...

...copayment that a patient, pursuant to a health insurance or health care policy, contract, or plan that covers psychological services, would otherwise be required to pay if the waiver is used as an enticement to a patient or group of patients to receive health care services from that provider; (12) Advertising that the person will waive the payment of all or any part of a deductible or copayment that a patient, pur...

...y authority of States to protect public health and safety through the current system of State licensure, while also providing for licensure portability through a Compact Privilege granted to qualifying professionals. This Compact is designed to achieve the following objectives: A. Increase public access to dietetics services; B. Provide opportunities for interstate practice by Licensed Dietitians who meet unifo...

...copayment that a patient, pursuant to a health insurance or health care policy, contract, or plan that covers applied behavior analysis services, would otherwise be required to pay if the waiver is used as an enticement to a patient or group of patients to receive health care services from that provider; (11) Advertising that the person will waive the payment of all or any part of a deductible or copayment that a p...

... environmental protection that a public health nuisance caused by an occasion of unavoidable urgency and suddenness due to unsanitary conditions compels the immediate construction of sewers for the protection of the public health and welfare; (b) The issuance of an order by the board of health of a health district to mitigate or abate a public health nuisance that is caused by an occasion of unavoidable urgency and ...

...ubmit to the United States secretary of health and human services a Title IV-A state plan for Title IV-A programs; (2) Prepare and submit to the United States secretary of health and human services amendments to the Title IV-A state plan that the department determines necessary, including amendments necessary to implement Title IV-A programs identified in divisions (A)(4)(c) to (h) of this section; (3) Prescrib...

...e Revised Code shall be responsible for decisions relating to medical diagnosis, treatment, rehabilitation, quality assurance, and the clinical aspects of the following: licensure of hospitals and residential facilities, research, community addiction and mental health plans, and certification and delivery of addiction services and mental health services. (B) The director shall: (1) Adopt rules for the proper exec...

...The director of mental health and addiction services, with respect to all mental health and addiction facilities, addiction services, mental health services, and recovery supports established and operated or provided under Chapter 340. of the Revised Code, shall do all of the following: (A) Adopt rules pursuant to Chapter 119. of the Revised Code that may be necessary to carry out the purposes of this chapter and Ch...

...n application to the director of mental health and addiction services. On receipt of the application, the director shall determine whether the standards established by divisions (B) and (C) of this section and any rules adopted under this section are satisfied or continue to be satisfied by the applicant. As part of the determination the director may conduct an on-site review of the applicant. In doing so, the direct...

... to any person for any acts, omissions, decisions, or other conduct within the scope of the functions of the quality assurance program. (3) Nothing in this section shall relieve any institution or individual from liability arising from the treatment of a patient. (E) Quality assurance records may be disclosed, and testimony may be provided concerning quality assurance records, only to the following persons or entit...

... to any person for any acts, omissions, decisions, or other conduct within the scope of the functions of the quality assurance program. (3) Nothing in this section shall relieve any institution or individual from liability arising from the treatment of a patient. (E) Quality assurance records may be disclosed, and testimony may be provided concerning quality assurance records, only to the following persons or entit...

...ation creates a substantial risk to the health and safety of residents of a residential facility. (2) The director may terminate a license if more than twelve consecutive months have elapsed since the residential facility was last occupied by a resident or a notice required by division (J) of this section is not given. (3) The director may issue an order for the suspension of admissions to a facility for any vi...

...ies at law are adequate to protect the health, safety, and welfare of the residents. Conditions at the facility that may present such risk of harm include, but are not limited to, instances when any of the following occur: (1) The residential facility is in violation of state or federal law or regulations. (2) The facility has had its license revoked or procedures for revocation have been initiated, or the f...

...on or property for any acts, omissions, decisions, or other conduct within the scope of the functions of the quality assurance program. (3) Nothing in this section shall relieve any institution from liability arising from the treatment of a patient. (F) Quality assurance records may be disclosed, and testimony may be provided concerning quality assurance records, only to the following persons or entities or under...

...nation made by the department of mental health and addiction services under section 5119.40 of the Revised Code or by the department of developmental disabilities under section 5123.021 of the Revised Code. If the individual is an applicant for or recipient of medicaid, the individual may appeal pursuant to section 5160.31 of the Revised Code. If the individual is not an applicant for or recipient of medicaid, ...