Ohio Revised Code Search

...doing business. (4) The Ohio life and health insurance guaranty association may require a member insurer to report any offset to the association. (B) A member insurer that is exempt from taxes described in division (A) of this section may recoup its assessments by a surcharge on its premiums in a sum reasonably calculated to recoup the assessments over a reasonable period of time, as approved by the superintenden...

...are provided by a pharmacist or nursing home. (C) "Covered vision services" means vision care services or vision care materials for which a reimbursement is available under an enrollee's health care contract, or for which a reimbursement would be available but for the application of contractual limitations, such as a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitatio...

...es pursuant to the contracting entity's health care contract with the participating provider unless one of the following applies: (a) The third party accessing the participating provider's services under the health care contract is an employer or other entity providing coverage for health care services to its employees or members, and that employer or entity has a contract with the contracting entity or its affilia...

...(A) Each health care contract shall include all of the following information: (1)(a) Information sufficient for the participating provider to determine the compensation or payment terms for health care services, including all of the following, subject to division (A)(1)(b) of this section: (i) The manner of payment, such as fee-for-service, capitation, or risk; (ii) The fee schedule of procedure codes reasonabl...

...(A)(1) If an amendment to a health care contract is not a material amendment, the contracting entity shall provide the participating provider notice of the amendment at least fifteen days prior to the effective date of the amendment. The contracting entity shall provide all other notices to the participating provider pursuant to the health care contract. (2) A material amendment to a health care contract shall...

... by the council for affordable quality healthcare (CAQH) in electronic or paper format for physicians. The department of insurance also shall prepare the standard credentialing form for all other providers and shall make the standard credentialing form as simple, straightforward, and easy to use as possible, having due regard for those credentialing forms that are widely in use in the state by contracting e...

...he terms of the contract for any basic health care services, specialty health care services, or supplemental health care services the provider provided to enrollees starting at the expiration of that ninety-day period until the provider's credentialing application is granted or denied. When the credentialing process of the contracting entity exceeds the ninety-day period, the contracting entity shall sele...

...(A) All remittance notices sent by a payer, whether written or electronic, shall include both of the following: (1) The name of the payer issuing the payment to the participating provider; (2) The name of the contracting entity through which the payment rate and any discount are claimed, if the contracting entity is different from the payer. (B) Division (A) of this section takes effect March 31, 2009.

...The superintendent of insurance shall adopt any rules necessary for the implementation of this chapter.

...(A) A series of violations of this chapter by any person regulated by the department of insurance under Title XVII or Title XXXIX of the Revised Code that, taken together, constitute a pattern or practice of violating this chapter may be defined as an unfair and deceptive insurance practice under sections 3901.19 to 3901.26 of the Revised Code. (B) The superintendent of insurance may conduct a market conduct ...

...a state agency, or federal agency for health care services provided through a program for medicaid or medicare; (B) A contract for payments made to providers for rendering health care services to claimants pursuant to claims made under Chapter 4121., 4123., 4127., or 4131. of the Revised Code; (C) An exclusive contract between a health insuring corporation and a single group of providers in a specific geo...

... following: (1) Offer to a provider a health care contract that includes a most favored nation clause; (2) Enter into a health care contract with a provider that includes a most favored nation clause; (3) Amend or renew an existing health care contract previously entered into with a provider so that the contract as amended or renewed adds or continues to include a most favored nation clause. (B) As used in ...

...act entered into between an owner and a home construction service supplier under which payment to the supplier is based on the cost of a product plus the supplier's rate for labor to install the product plus an agreed percentage of profit or a stipulated fee. (B) "Home construction service" means the construction of a residential building, including the creation of a new structure and the repair, improvement, remod...

...ed in division (C) of this section, no home construction service supplier shall perform any home construction service the cost of which equals or exceeds twenty-five thousand dollars unless the supplier enters into a written home construction services contract with the owner. The contract shall include all agreements and conditions related to the home construction service, including all of the following: (1) ...

...(A) No home construction service supplier shall do any of the following: (1) Prior to commencing work related to the home construction service, fail to enter into a written contract that complies with this chapter; (2) After entering into a contract with an owner and prior to commencing any work that is related to an excess cost, fail to provide an estimate of the excess costs as this chapter requires; (3) A...

...A home construction service supplier may take as a down payment not more than ten per cent of the contract price before the supplier's performance that is required by the contract begins, except a supplier may take as a down payment not more than seventy-five per cent of the total cost of any special order item that is otherwise not returnable or usable before the supplier's performance that is required by the ...

...(A) If, by the attorney general's own inquiries or as a result of complaints, the attorney general has reasonable cause to believe that a person has engaged or is engaging in an act or practice that violates this chapter, the attorney general may investigate. (B) For this purpose, the attorney general may administer oaths, subpoena witnesses, adduce evidence, and require the production of relevant matter. If...

...n behalf of owners who have engaged in home construction service contracts in this state for damage caused by an act or practice described in this chapter. (B) On motion of the attorney general and without bond, in the attorney general's action under this section, the court may make appropriate orders, including appointment of a referee or a receiver, for sequestration of assets, to reimburse owners found to ...

...ined the action in bad faith; (2) The home construction service supplier has knowingly committed an act or practice that violates this chapter. (E) As used in this section, "actual economic damages" means damages for direct, incidental, or consequential pecuniary losses resulting from a violation of Chapter 4722. of the Revised Code and does not include damages for noneconomic loss as defined in section 2315....

...utive license. (C) "Licensed nursing home administrator" means an individual who holds a valid nursing home administrator license. (D) "Long-term services and supports setting" means any institutional or community-based setting in which medical, health, psychosocial, habilitative, rehabilitative, or personal care services are provided to individuals on a post-acute care basis. (E) "Nursing home" means a nurs...

...)(2)(a) of this section shall be a home health administrator, hospice administrator, an owner of a home health agency or hospice care program, or an officer of a home health agency or hospice care program. (3) One member who is a member of the academic community; (4) One member who is a consumer of services, or who represents a consumer of services, in a long-term services and supports setting; (5) One nonvo...

...(A) The board of executives of long-term services and supports shall enter into a written agreement with the department of aging for the department to serve as the board's fiscal agent. The fiscal agent shall be responsible for all the board's fiscal matters and financial transactions, as specified in the agreement. The written agreement shall specify the fees that the board shall pay to the fiscal agent for services...

...There is hereby created in the state treasury the board of executives of long-term services and supports fund. The fund shall consist of the amounts the board of executives of long-term services and supports collects under this chapter as fees, civil penalties, and fines. The board shall use the money in the fund to administer and enforce this chapter and the rules adopted under section 4751.04 of the Revised Code. I...

...The board of executives of long-term services and supports shall adopt rules in accordance with Chapter 119. of the Revised Code as necessary to implement and enforce this chapter.

...llowing unless the person is a licensed health services executive: (1) The title "licensed health services executive" or "health services executive"; (2) The acronym "LHSE," "L.H.S.E.," "HSE," or "H.S.E." after the person's name; (3) Any other words, letters, signs, cards, or devices that tend to indicate or imply that the person is a licensed health services executive. (E) Sell, fraudulently furnish, fra...