reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5164.911 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.911 | Integrated Care Delivery System Evaluation.

Effective: March 20, 2014|Latest Legislation:  Senate Bill 206 - 130th General Assembly|(A) If the medicaid director implements the integrated care delivery system and except as provided in division (C) of this section, the director shall annually evaluate all of the following: (1) The health outcomes of ICDS participants;(2) How changes to the administration of the ICDS affect all of the following:(a) Claims processing;(b) The appeals process;(c) The number of reassessments requested;(d) Prior authorization requests for services.(3) The provider panel selection process used by medicaid managed care organizations participating in the ICDS.(B) When conducting an evaluation under division (A) of this section, the director shall do all of the following:(1) For the purpose of division (A)(1) of this section, do both of the following:(a) Compare the health outcomes of ICDS participants to the health outcomes of individuals who are not ICDS participants;(b) Use both of the following:(i) A control group consisting of ICDS participants who receive health care services from providers not participating in ICDS;(ii) A control group consisting of ICDS participants who receive health care services from alternative providers that are not part of a participating medicaid managed care organization's provider panel but provide health care services in the geographic service area in which ICDS participants receive health care services.(2) For the purpose of division (A)(2) of this section, do all of the following:(a) To the extent the data is available, use data from all of the following:(i) The fee-for-service component of the medicaid program;(ii) Medicaid managed care organizations;(iii) Managed care organizations participating in the medicare advantage program established under Part C of Title XVIII of the "Social Security Act," 42 U.S.C. 1395w-21 et seq.(b) Identify all of the following:(i) Changes in the amount of time it takes to process claims and the number of claims denied and the reasons for the changes;(ii) The impact that changes to the administration of the ICDS had on the appeals process and number of reassessments requested;(iii) The number of prior authorization denials that were overturned and the reasons for the overturned denials.(3) Require medicaid managed care organizations participating in the ICDS to submit to the director any data the director needs for the evaluation.(C) The director is not required to conduct an evaluation under this section for a year if the same evaluation is conducted for that year by an organization under contract with the United States department of health and human services. Last updated May 6, 2021 at 5:21 PM
Ohio Rev Code § 5164.912 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.912 | Integrated Care Delivery System Standardized Claim Form.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The medicaid director shall select from among universally accepted claim forms used in the United States a standardized claim form for each type of medicaid provider that provides medicaid services under the integrated care delivery system. The director shall create standardized claim codes to be used on the standardized claim forms. Each medicaid provider and medicaid provider's designee that bills for medicaid services provided under the integrated care delivery system shall use the appropriate standardized claim form and standardized claim codes. Last updated May 6, 2021 at 5:22 PM
Ohio Rev Code § 5164.92 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.92 | Advanced Diagnostic Imaging Services Coverage Under Medicaid Program.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|As used in this section, "advanced diagnostic imaging services" means magnetic resonance imaging services, computed tomography services, positron emission tomography services, cardiac nuclear medicine services, and similar imaging services. The department of medicaid shall implement evidence-based, best practice guidelines or protocols and decision support tools for advanced diagnostic imaging services covered by the fee-for-service component of the medicaid program.
Ohio Rev Code § 5164.93 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.93 | Incentive Payments for Adoption and Use of Electronic Health Record Technology.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) The department of medicaid may establish a program under which it provides incentive payments, as authorized by the "Social Security Act," section 1903(a)(3)(F) and (t), 42 U.S.C. 1396b(a)(3)(F) and (t), to encourage the adoption and use of electronic health record technology by medicaid providers who are identified under that federal law as eligible professionals. (B) After the department has made a determination regarding the amount of a medicaid provider's electronic health record incentive payment or the denial of an incentive payment, the department shall notify the provider. The provider may request that the department reconsider its determination.A request for reconsideration shall be submitted in writing to the department not later than fifteen days after the provider receives notification of the determination. The request shall be accompanied by written materials setting forth the basis for, and supporting, the reconsideration request.On receipt of a timely request, the department shall reconsider the determination. On the basis of the written materials accompanying the request, the department may uphold, reverse, or modify its original determination. The department shall mail to the provider by certified mail a written notice of the reconsideration decision.In accordance with Chapter 2505. of the Revised Code, the medicaid provider may appeal the reconsideration decision by filing a notice of appeal with the court of common pleas of Franklin county. The notice shall identify the decision being appealed and the specific grounds for the appeal. The notice of appeal shall be filed not later than fifteen days after the department mails its notice of the reconsideration decision. A copy of the notice of appeal shall be filed with the department not later than three days after the notice is filed with the court.(C) The medicaid director may adopt rules under section 5162.02 of the Revised Code as necessary to implement this section. The rules, if any, shall be adopted in accordance with Chapter 119. of the Revised Code.
Ohio Rev Code § 5164.94 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.94 | Delivery of Services in Culturally and Linguistically Appropriate Manners.

Effective: March 20, 2014|Latest Legislation:  Senate Bill 206 - 130th General Assembly|The medicaid director shall implement within the medicaid program a system that encourages medicaid providers to provide medicaid services to medicaid recipients in culturally and linguistically appropriate manners.
Ohio Rev Code § 5164.95 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.95 | Standards for Payments for Telehealth Services.

Effective: May 20, 2014|Latest Legislation:  House Bill 123 - 130th General Assembly|(A) As used in this section, "telehealth service" means a health care service delivered to a patient through the use of interactive audio, video, or other telecommunications or electronic technology from a site other than the site where the patient is located. (B) The department of medicaid shall establish standards for medicaid payments for health care services the department determines are appropriate to be covered by the medicaid program when provided as telehealth services. The standards shall be established in rules adopted under section 5164.02 of the Revised Code.
Ohio Rev Code § 5164.951 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.951 | Standards for Medicaid Payments for Services Provided Through Teledentistry.

Effective: March 20, 2019|Latest Legislation:  Senate Bill 259 - 132nd General Assembly|As used in this section, "teledentistry" has the same meaning as in section 4715.43 of the Revised Code. The department of medicaid shall establish standards for medicaid payments for services provided through teledentistry. The standards shall provide coverage for services to the same extent that those services would be covered by the medicaid program if the services were provided without the use of teledentistry.
Ohio Rev Code § 5165.011 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.011 | Nursing Facility References.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) Except as provided in division (B) of this section, whenever "skilled nursing facility," "intermediate care facility," or "dual skilled nursing and intermediate care facility" is referred to or designated in any statute, rule, contract, provider agreement, or other document pertaining to the medicaid program, the reference or designation is deemed to refer to a nursing facility. (B) A reference to or designation of an "intermediate care facility for individuals with intellectual disabilities" or "ICF/IID" is not deemed to refer to a nursing facility.
Ohio Rev Code § 5165.02 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.02 | Rules.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
Ohio Rev Code § 5165.031 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.031 | Hearing.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|An individual who applies for admission to or resides in a nursing facility may appeal if adversely affected by a determination 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, the individual may appeal pursuant to a process the department of medicaid shall establish, which shall be similar to the appeals process established by section 5101.35 of the Revised Code. The department of medicaid shall provide notice of the right to appeal to individuals adversely affected by determinations made under sections 5119.40 and 5123.021 of the Revised Code. Any decision made on the basis of such an appeal is binding on the department of mental health and addiction services and the department of developmental disabilities.
Ohio Rev Code § 5165.06 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.06 | Nursing Facility Eligibility.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|Subject to section 5165.072 of the Revised Code, an operator is eligible to enter into a provider agreement for a nursing facility if all of the following apply: (A) The nursing facility is certified by the director of health for participation in medicaid;(B) The nursing facility is licensed by the director of health as a nursing home if so required by law;(C) The operator and nursing facility comply with all applicable state and federal laws and rules.
Ohio Rev Code § 5165.07 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.07 | Provider Agreement Requirements.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) Except as provided in section 5165.072 of the Revised Code, the department of medicaid shall enter into a provider agreement with a nursing facility operator who applies, and is eligible, for the provider agreement. (B) A provider agreement shall require the department to make medicaid payments to the provider in accordance with this chapter for nursing facility services the nursing facility provides to its residents who are medicaid recipients eligible for nursing facility services.(C) A provider agreement shall require the provider to do all of the following:(1) Maintain eligibility for the provider agreement as provided in section 5165.06 of the Revised Code;(2) Keep records relating to a cost reporting period for the greater of seven years after the cost report is filed or, if the department issues an audit report in accordance with section 5165.109 of the Revised Code, six years after all appeal rights relating to the audit report are exhausted;(3) File reports as required by the department;(4) Open all records relating to the costs of the nursing facility's services for inspection and audit by the department;(5) Open its premises for inspection by the department, the department of health, and any other state or local authority having authority to inspect;(6) Supply to the department such information as it requires concerning the nursing facility's services to residents who are, or are eligible to be, medicaid recipients;(7) Comply with section 5165.08 of the Revised Code.(D) A provider agreement may contain other provisions that are consistent with law and considered necessary by the department.
Ohio Rev Code § 5165.071 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.071 | Facility Operator May Contract With More Than One Provider.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|A nursing facility operator may enter into provider agreements for more than one nursing facility.
Ohio Rev Code § 5165.072 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.072 | Revalidation.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall not revalidate a nursing facility provider agreement if the provider fails to maintain eligibility for the provider agreement as provided in section 5165.06 of the Revised Code.
Ohio Rev Code § 5165.073 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.073 | Termination for Non-Compliance With Installation of Fire Extinguishing and Fire Alarm Systems.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall terminate the provider agreement with a nursing facility provider that does not comply with the requirements of section 3721.071 of the Revised Code for the installation of fire extinguishing and fire alarm systems.
Ohio Rev Code § 5165.081 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.081 | Action Against Facility for Breach of Provider Agreement or Other Duties.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|A nursing facility resident has a cause of action against a nursing facility provider for breach of the provider agreement obligations or other duties imposed by section 5165.08 of the Revised Code. The action may be commenced by the resident, or on the resident's behalf by the resident's sponsor or a residents' rights advocate, by the filing of a civil action in the court of common pleas of the county in which the nursing facility is located, or in the court of common pleas of Franklin county. If a court of common pleas finds that a provider has breached a provider agreement obligation or other duty imposed by section 5165.08 of the Revised Code, the court may do one or more of the following:(A) Enjoin the provider from engaging in the practice;(B) Order such affirmative relief as may be necessary;(C) Award to a resident and a sponsor or government entity that brings the action on behalf of a resident actual damages, costs, and reasonable attorney's fees.
Ohio Rev Code § 5165.082 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.082 | Qualification of Beds.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) Except as provided in division (B) of this section, the operator of a nursing facility that elects to have the nursing facility participate in the medicaid program shall qualify all of the nursing facility's medicaid-certified beds in the medicare program. The medicaid director may adopt rules under section 5165.02 of the Revised Code to establish the time frame in which a nursing facility must comply with this requirement. (B) The department of veterans services is not required to qualify all of the medicaid-certified beds in a nursing facility the department maintains and operates under section 5907.01 of the Revised Code in the medicare program.
Ohio Rev Code § 5165.10 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.10 | Annual Cost Report.

Effective: September 15, 2014|Latest Legislation:  House Bill 483 - 130th General Assembly|(A) Except as provided in division (C) of this section, each nursing facility provider shall file with the department of medicaid an annual cost report for each of the provider's nursing facilities that participate in the medicaid program. The cost report for a year shall cover the calendar year or the portion of the calendar year during which the nursing facility participated in the medicaid program. Except as provided in division (D) of this section, the cost report is due not later than ninety days after the end of the calendar year, or portion of the calendar year, that the cost report covers. (B) If a nursing facility undergoes a change of provider that the department determines, in accordance with rules adopted under section 5165.02 of the Revised Code, is not an arm's length transaction, the new provider shall file the nursing facility's cost report in accordance with division (A) of this section and the cost report shall cover the portion of the calendar year during which the new provider operated the nursing facility and the portion of the calendar year during which the previous provider operated the nursing facility.(C) The provider of a new nursing facility is not required to file a cost report in accordance with division (A) of this section for the first calendar year that the provider has a provider agreement for the nursing facility if the initial provider agreement goes into effect after the first day of October of that calendar year. The provider shall file a cost report for the nursing facility in accordance with division (A) of this section for the immediately following calendar year.(D) The department may grant to a provider a fourteen-day extension to file a cost report under this section if the provider provides the department a written request for the extension and the department determines that there is good cause for the extension.
Ohio Rev Code § 5165.101 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.101 | Cost of Franchise Permit Fee Not Reimbursable Expense.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|A nursing facility provider filing the nursing facility's cost report with the department of medicaid under section 5165.10 or 5165.522 of the Revised Code shall report as a nonreimbursable expense the cost of the nursing facility's franchise permit fee.
Ohio Rev Code § 5165.102 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.102 | Fines Excluded From Cost Report.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|No nursing facility provider shall report fines paid under sections 5165.60 to 5165.89 or section 5165.99 of the Revised Code in a cost report filed under section 5165.10 or 5165.522 of the Revised Code.
Ohio Rev Code § 5165.103 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.103 | Completion of Cost Reports.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|Cost reports shall be completed using the form prescribed under section 5165.104 of the Revised Code and in accordance with the guidelines established under that section.
Ohio Rev Code § 5165.104 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.104 | Form of Cost Reports; Guidelines.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall do all of the following: (A) Prescribe the form to be used for completing a cost report and a uniform chart of accounts for the purpose of reporting costs on the form;(B) Distribute a paper copy of the form, or computer software for electronic submission of the form, to each provider at least sixty days before the date the cost report is due;(C) Establish guidelines for completing the form.
Ohio Rev Code § 5165.105 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.105 | Addendum for Disputed Costs.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall develop an addendum to the cost report form that a nursing facility provider may use to set forth costs that the provider believes the department may dispute. The department may consider such costs in determining a nursing facility's medicaid payment rate. If the department does not consider such costs in determining a nursing facility's medicaid payment rate, the provider may seek reconsideration of the determination in accordance with section 5165.38 of the Revised Code. If the department subsequently includes such costs in a nursing facility's medicaid payment rate, the department shall pay the provider interest at a reasonable rate established in rules adopted under section 5165.02 of the Revised Code for the period that the rate excluded the costs.