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medical procedure definition
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Section 5160.371 | Disclosure of third-party payer information.

...partment of job and family services, a medical assistance recipient and the recipient's attorney, if any, shall cooperate with each medical provider of the recipient. Cooperation with a medical provider shall consist of disclosing to the provider all information the recipient and attorney, if any, possess that would assist the provider in determining each third party that is responsible for the payment or proc...

Section 5160.38 | Assignment of rights to department.

...e application for, or enrollment in, a medical assistance program constitutes an automatic assignment of rights specified in division (B) of this section to the department of medicaid. This assignment includes the rights of the medical assistance recipient and also the rights of any other member of the assistance group for whom the recipient can legally make an assignment. (B) Pursuant to this section, a medi...

Section 5160.39 | Third-party cooperation regarding liability information.

...lishing third party liability regarding medical assistance programs. (B) In furtherance of the requirement in division (A) of this section and to allow the department to determine any period that the individual or the individual's spouse or dependent may have been covered by the third party and the nature of the coverage, a third party shall provide, as the department so chooses, information or access to info...

Section 5160.40 | Third-party duties; medicaid managed care organizations.

...ment regarding a claim for payment of a medical item or service that was submitted to the third party not later than six years after the date of the provision of such medical item or service; (3) Respond to the department's request for payment of a claim described in division (B)(2) of this section not later than sixty business days after receipt of written proof of the claim, either by paying the claim or issuing...

Section 5160.401 | Finality of payments.

...evised Code on a claim for payment of a medical item or service provided to a medical assistance recipient is final on the date that is two years after the payment was made to the department of medicaid or the applicable medicaid managed care organization. After a claim is final, the claim is subject to adjustment only if an action for recovery of an overpayment was commenced under division (B) of this section before...

Section 5160.41 | Excluded considerations for third-party medical assistance.

...vidual is eligible for or enrolled in a medical assistance program when either of the following applies: (A) The individual seeks to obtain a policy or enroll in a plan or program operated or administered by the third party; (B) The individual, or a person or governmental entity on the individual's behalf, seeks payment for a medical item or service provided to the individual.

Section 5160.42 | Sanctions against third parties for violations.

...(A) If a third party violates section 5160.39, 5160.40, or 5160.41 of the Revised Code, a governmental entity that is responsible for issuing a license, certificate of authority, registration, or approval that authorizes the third party to do business in this state may impose a fine against the third party or deny, revoke, or terminate the third party's license, certificate, registration, or approval to do busi...

Section 5160.43 | Adoption of rules regarding recovery of costs.

...the following: (1) For purposes of the definition of "information" in division (A) of section 5160.35 of the Revised Code, any data other than the data specified in that division that should be included in the definition. (2) For purposes of division (C)(1)(a) of section 5160.39 of the Revised Code, the medium, format, and manner in which a third party must provide information to the department. (3) For purpo...

Section 5160.45 | Disclosure of medical assistance information.

...use or disclose information regarding a medical assistance recipient for any purpose not directly connected with the administration of a medical assistance program. (C) Both of the following shall be considered to be purposes directly connected with the administration of a medical assistance program: (1) Treatment, payment, or other operations or activities authorized by 42 C.F.R. Chapter IV; (2) Any administ...

Section 5160.46 | Authorization form.

...ment, enrollment, or eligibility for a medical assistance program cannot be conditioned on signing the authorization unless the authorization is necessary for determining eligibility for the program. (B) An authorization for the release of information regarding a medical assistance recipient to the recipient's attorney under division (D)(3) of section 5160.45 of the Revised Code may include a provision specifi...

Section 5160.47 | Membership in the public assistance reporting information system and other multistate cooperatives.

...nt may disclose information regarding a medical assistance recipient to the extent necessary to participate as an active member in the public assistance reporting information system or other multistate cooperative.

Section 5160.471 | Review to determine eligibility for federal military-related health care benefits.

...etermine whether an individual who is a medical assistance recipient may be eligible for federal military-related health care benefits. If the department determines that the individual may be eligible for federal military-related health care benefits, it shall notify the individual of the potential eligibility and encourage the individual to contact the veterans service commission in the county in which the individua...

Section 5160.48 | Rules for conditions and procedures for the release of information.

...The rules shall specify conditions and procedures for the release of information, which may include both of the following: (1) Permitting a provider of a service under a medical assistance program limited access to information that is essential for the provider to render the service or to bill for the service rendered; (2) Permitting a contractor, grantee, or other state or county entity limited access to in...

Section 5160.481 | Adoption of rules by other agencies.

...sses, or other information relating to medical assistance recipients is held by any agency other than the department of medicaid or a county department of job and family services, that other agency shall adopt rules consistent with sections 5160.45 to 5160.481 of the Revised Code to prevent the publication or disclosure of names, lists, or other information concerning those recipients.

Section 5160.50 | Refugee medical assistance program.

... medicaid shall administer the refugee medical assistance program authorized by the "Immigration and Nationality Act," section 412(e), 8 U.S.C. 1522(e).

Section 5160.52 | Authority to enter into interstate compacts for provision of medical assistance to children.

...any other states, for the provision of medical assistance to children in relation to whom all of the following apply: (A) They have special needs. (B) This state or another state that is a party to the interstate compact is providing adoption assistance on their behalf. (C) They move into this state from another state or move out of this state to another state.

Section 5160.99 | Penalty for unlawful disclosure of information.

...Whoever violates division (B) of section 5160.45 of the Revised Code is guilty of a misdemeanor of the first degree.

Section 5701.01 | Person defined.

...As used in Title LVII of the Revised Code, "person" includes individuals, firms, companies, business trusts, estates, trusts, partnerships, limited liability companies, associations, corporations, and any other business entities.

Section 5701.02 | Real property definitions.

...As used in Title LVII of the Revised Code: (A) "Real property," "realty," and "land" include land itself, whether laid out in town lots or otherwise, all growing crops, including deciduous and evergreen trees, plants, and shrubs, with all things contained therein, and, unless otherwise specified in this section or section 5701.03 of the Revised Code, all buildings, structures, improvements, and fixtures of whatever ...

Section 5701.03 | Personal property and business fixture defined.

...As used in Title LVII of the Revised Code: (A) "Personal property" includes every tangible thing that is the subject of ownership, whether animate or inanimate, including a business fixture, and that does not constitute real property as defined in section 5701.02 of the Revised Code. "Personal property" also includes every share, portion, right, or interest, either legal or equitable, in and to every ship, vessel, o...

Section 5701.04 | Money defined.

...As used in Title LVII of the Revised Code, "money" includes gold, silver, and other coin, circulating notes of national banking associations, United States legal tender notes, and other notes and certificates of the United States payable on demand and circulating or intended to circulate as currency.

Section 5701.05 | Deposits defined.

...As used in Title LVII of the Revised Code other than in division (A)(7) of section 5733.056 of the Revised Code, "deposits" includes every deposit which the person owning, holding in trust, or having the beneficial interest therein is entitled to withdraw in money, whether on demand or not, and whether evidenced by commercial or checking account, certificate of deposit, savings account, certificates of running, or ot...

Section 5701.06 | Investments defined.

...As used in Title LVII of the Revised Code, "investments" includes: (A) Shares of stock in corporations, associations, and joint-stock companies, under whatever laws organized or existing, excepting: (1) Those which are instrumentalities of the federal government for the taxation of which by the several states no provision is made by act of the congress of the United States; (2) Those in financial institutions, dea...

Section 5701.07 | Credits, current accounts, prepaid items defined.

...As used in Title LVII of the Revised Code: (A) "Credits" means the excess of the sum of all current accounts receivable and prepaid items used in business when added together, estimating every such account and item at its true value in money, over and above the sum of current accounts payable of the business, other than taxes and assessments. (B) "Current accounts" includes items receivable or payable on demand or ...

Section 5701.08 | Used in business, business defined.

...As used in Title LVII of the Revised Code: (A) Personal property is "used" within the meaning of "used in business" when employed or utilized in connection with ordinary or special operations, when acquired or held as means or instruments for carrying on the business, when kept and maintained as a part of a plant capable of operation, whether actually in operation or not, or when stored or kept on hand as material,...