reglab/housing_qa huggingface dataset:
Ohio Rev Code § 1751.691 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.691 | Prior Authorization Requirements or Other Utilization Review Measures as Conditions of Providing Coverage of an Opioid Analgesic.

Effective: April 6, 2017|Latest Legislation:  Senate Bill 319 - 131st General Assembly|(A) As used in this section: (1) "Benzodiazepine" has the same meaning as in section 3719.01 of the Revised Code. (2) "Chronic pain" has the same meaning as in section 4731.052 of the Revised Code. (3) "Hospice care program" and "hospice patient" have the same meanings as in section 3712.01 of the Revised Code. (4) "Opioid analgesic" has the same meaning as in section 3719.01 of the Revised Code. (5) "Prescriber" has the same meaning as in section 4729.01 of the Revised Code. (6) "Terminal condition" means an irreversible, incurable, and untreatable condition that is caused by disease, illness, or injury and will likely result in death. A terminal condition is one in which there can be no recovery, although there may be periods of remission. (B)(1) An individual or group health insuring corporation policy, contract, or agreement that is delivered, issued for delivery, or renewed in this state and covers prescription drugs shall contain prior authorization requirements or other utilization review measures as conditions of providing coverage of an opioid analgesic prescribed for the treatment of chronic pain, except when the drug is prescribed under one of the following circumstances: (a) To an individual who is a hospice patient in a hospice c are program; (b) To an individual who has been diagnosed with a terminal condition but is not a hospice patient in a hospice care program; (c) To an individual who has cancer or another condition associated with the individual's cancer or history of cancer. (2) When implementing division (B)(1) of this section, the health insuring corporation shall consider either or both of the following, as applicable to the case in which the opioid analgesic is prescribed: (a) If the course of treatment with the drug continues for more than ninety days, the requirements of section 4731.052 of the Revised Code; (b) If the morphine equivalent daily dose for the drug exceeds eighty milligrams or the individual is being treated with a benzodiazepine at the time the opioid analgesic is prescribed, the guidelines established by the governor's cabinet opiate action team and presented in the document titled "Ohio Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-terminal Pain 80 mg of a Morphine Equivalent Daily Dose (MED) 'Trigger Point'" or a successor document, unless the guidelines are no longer in effect at the time the opioid analgesic is prescribed. (C) If a health insuring corporation measures the efficiency, quality of care, or clinical performance of a prescriber, including through the use of patient satisfaction surveys, it shall not penalize the prescriber, financially or otherwise, for deciding not to prescribe an opioid analgesic.
Ohio Rev Code § 1751.70 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.70 | Authorization of Payroll Deductions for Public Employees.

Effective: June 4, 1997|Latest Legislation:  Senate Bill 67 - 122nd General Assembly|(A) An employee of the state, of any political subdivision of the state, or of any institution supported in whole or in part by the state, may authorize the deduction from the employee's salary or wages of the amount of the employee's premium rate to any health insuring corporation holding a certificate of authority pursuant to this chapter. The employee's authorization shall be evidenced by approval of the head of the department, division, office, or institution in which the employee is employed.(B) In the case of employees of the state, the employee's authorization shall be directed to and filed with the director of administrative services. In the case of employees of a political subdivision, the employee's authorization shall be directed to and filed with the fiscal officer of such political subdivision. In the case of employees of any institution supported in whole or in part by the state, the employee's authorization shall be directed to and filed with the fiscal officer of such institution.(C) Upon the filing of the employee's authorization in accordance with division (B) of this section, the director or fiscal officer shall provide for payment to the health insuring corporation referred to in the employee's authorization, for the amount covering the sum of the deductions thereby authorized.
Ohio Rev Code § 1751.71 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.71 | Accepting Payments for Cost of Policies, Contracts, and Agreements.

Effective: June 4, 1997|Latest Legislation:  Senate Bill 67 - 122nd General Assembly|Each health insuring corporation subject to this chapter may accept from governmental agencies, or from private persons, payments covering all or part of the cost of policies, contracts, and agreements entered into between the health insuring corporation and its subscribers or groups of subscribers.
Ohio Rev Code § 1751.73 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.73 | Implementing Quality Assurance Programs.

Effective: October 1, 1998|Latest Legislation:  House Bill 361 - 122nd General Assembly|Each health insuring corporation providing basic health care services shall implement a quality assurance program for use in connection with those policies, contracts, and agreements providing basic health care services. Each health insuring corporation required to implement a quality assurance program shall annually file a certificate with the superintendent of insurance certifying that its quality assurance program does all of the following:(A) Identifies a corporate board or committee or designates an executive staff person responsible for program implementation and compliance;(B) Includes a process enabling the selection and retention of quality providers and health care facilities through credentialing, recredentialing, and monitoring procedures;(C) Provides for ongoing monitoring of the quality assurance program;(D) Assures a process for compliance by any entity or entities with which the health insuring corporation contracts for services;(E) Includes a process to take remedial action to correct quality problems.
Ohio Rev Code § 1751.75 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.75 | Determination That Accreditation Constitutes Compliance.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|A health insuring corporation may present evidence of compliance with the requirements of sections 1751.73 and 1751.74 of the Revised Code by submitting certification to the superintendent of insurance of its accreditation by an independent, private accrediting organization, such as the national committee on quality assurance, the national quality health council, the joint commission on accreditation of health care organizations, the accreditation association for ambulatory health care, or the American accreditation healthcare commission/utilization review accreditation commission. The superintendent, upon review of the organization's accreditation process, may determine that such accreditation constitutes compliance by the health insuring corporation with the requirements of these sections.
Ohio Rev Code § 1751.78 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.78 | Application of Provisions.

Effective: December 26, 2011|Latest Legislation:  House Bill 218 - 129th General Assembly|(A)(1) Sections 1751.77 to 1751.87 and Chapter 3922. of the Revised Code apply to any health insuring corporation that provides or performs utilization review services in connection with its policies, contracts, and agreements covering basic health care services and to any designee of the health insuring corporation, or to any utilization review organization that performs utilization review functions on behalf of the health insuring corporation in connection with policies, contracts, or agreements of the health insuring corporation covering basic health care services. (2) Nothing in sections 1751.77 to 1751.82 or section 1751.823 of the Revised Code shall be construed to require a health insuring corporation to provide or perform utilization review services in connection with health care services provided under a policy, plan, or agreement of supplemental health care services or specialty health care services.(B)(1) Each health insuring corporation shall be responsible for monitoring all utilization review and internal review activities carried out by, or on behalf of, the health insuring corporation and for ensuring that all requirements of sections 1751.77 to 1751.87 and Chapter 3922. of the Revised Code, and any rules adopted thereunder, are met. The health insuring corporation shall also ensure that appropriate personnel have operational responsibility for the conduct of the health insuring corporation's utilization review program.(2) If a health insuring corporation contracts to have a utilization review organization or other entity perform the utilization review functions required by sections 1751.77 to 1751.87 and Chapter 3922. of the Revised Code, and any rules adopted thereunder, the superintendent of insurance shall hold the health insuring corporation responsible for monitoring the activities of the utilization review organization or other entity and for ensuring that the requirements of those sections and rules are met.
Ohio Rev Code § 1751.79 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.79 | Utilization Review Program Requirements.

Effective: October 1, 1998|Latest Legislation:  House Bill 361 - 122nd General Assembly|A health insuring corporation that conducts utilization review shall prepare a written utilization review program that describes all review activities, both delegated and nondelegated, for covered health care services provided, including the following:(A) Procedures to evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services;(B) The use of data sources and clinical review criteria in making decisions;(C) Mechanisms to ensure consistent application of criteria and compatible decisions;(D) Data collection processes and analytical methods used in assessing utilization of health care services;(E) Mechanisms for assuring confidentiality of clinical and proprietary information;(F) The periodic assessment of utilization review activities, and the reporting of these assessments to the health insuring corporation's board, by a utilization review committee, a quality assurance committee, or any similar committee;(G) The functional responsibility for day-to-day program management by staff;(H) Defined methods by which guidelines are approved and communicated to providers and health care facilities.
Ohio Rev Code § 1751.80 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.80 | Implementing Utilization Review Programs.

Effective: October 1, 1998|Latest Legislation:  House Bill 361 - 122nd General Assembly|The utilization review program of a health insuring corporation shall be implemented in accordance with all of the following:(A) The program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health insuring corporation may develop its own clinical review criteria or may purchase or license such criteria from qualified vendors. A health insuring corporation shall make its clinical review rationale available upon request to authorized government agencies. The rationale made available to authorized government agencies is confidential and is not a public record as defined in section 149.43 of the Revised Code.(B) Qualified providers shall administer the program and oversee review determinations. A clinical peer in the same, or in a similar, specialty as typically manages the medical condition, procedure, or treatment under review shall evaluate the clinical appropriateness of adverse determinations that are the subject of an appeal.(C) The health insuring corporation shall issue utilization review determinations in a timely manner pursuant to the requirements of sections 1751.81 and 1751.82 of the Revised Code and the enrollee grievance requirements. The health insuring corporation shall obtain information required to make a utilization review determination, including pertinent clinical information, and shall establish a process to ensure that utilization reviewers apply clinical review criteria consistently.(D) If the health insuring corporation delegates any utilization review activities to a utilization review organization, the health insuring corporation shall maintain adequate oversight, including a process by which the health insuring corporation evaluates the performance of the organization, and shall maintain copies of both of the following:(1) A written description of the organization's activities and responsibilities, including reporting requirements;(2) Evidence of formal approval of the organization's program by the health insuring corporation.(E) The health insuring corporation or its designee utilization review organization shall provide enrollees and participating providers with access to its review staff by means of a toll-free telephone number or collect-call telephone line.(F) When conducting prospective or concurrent review, the health insuring corporation or its designee utilization review organization shall collect only the information necessary to certify the admission, procedure or treatment, length of stay, frequency, and duration of health care services.(G) Compensation to persons providing utilization review services for the health insuring corporation shall not contain incentives, direct or indirect, for them to make inappropriate review decisions.
Ohio Rev Code § 1751.811 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.811 | Internal and External Reviews.

Effective: December 26, 2011|Latest Legislation:  House Bill 218 - 129th General Assembly|In lieu of conducting a prospective, concurrent, or retrospective review under section 1751.81 of the Revised Code, providing a reconsideration under section 1751.82 of the Revised Code, or conducting an internal review under section 1751.83 of the Revised Code, a health insuring corporation may afford an enrollee an opportunity for an external review under section 3922.08 or 3922.10 of the Revised Code. If an external review is conducted pursuant to this section, the health insuring corporation is not required to afford the enrollee an opportunity for any of the reviews that were disregarded pursuant to this section, including the external review that may have resulted from a review that was disregarded pursuant to this section, unless new clinical information is submitted to the health insuring corporation.
Ohio Rev Code § 1751.82 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.82 | Reconsideration of Adverse Determination.

Effective: May 1, 2000|Latest Legislation:  House Bill 4 - 123rd General Assembly|(A) In a case involving a prospective determination or a concurrent review determination, a health insuring corporation shall give the provider or health care facility rendering the health care service an opportunity to request in writing on behalf of the enrollee a reconsideration of an adverse determination by the reviewer making the adverse determination. The provider or health care facility may not request a reconsideration without the prior consent of the enrollee. The reconsideration shall occur within three business days after the health insuring corporation's receipt of the written request for reconsideration, and shall be conducted between the provider or health care facility rendering the health care service and the reviewer who made the adverse determination. If that reviewer cannot be available within three business days, the reviewer may designate another reviewer.(B) If the reconsideration process described in division (A) of this section does not resolve the difference of opinion, the enrollee, an authorized person, or the provider or health care facility acting on behalf of the enrollee may request an internal review under section 1751.83 of the Revised Code. The provider or health care facility may not request an internal review without the prior consent of the enrollee.(C) Reconsideration is not a prerequisite to an internal or external review of an adverse determination.(D) The time period allowed by division (A) of this section for a reconsideration of an adverse determination shall not apply if the seriousness of the medical condition of the enrollee requires a more expedited reconsideration. The health insuring corporation shall maintain written procedures for making such an expedited reconsideration.
Ohio Rev Code § 1751.821 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.821 | Determination That Accreditation Constitutes Compliance.

Effective: May 1, 2000|Latest Legislation:  House Bill 4 - 123rd General Assembly|A health insuring corporation may present evidence of compliance with the requirements of sections 1751.77 to 1751.82 of the Revised Code by submitting evidence to the superintendent of insurance of its accreditation by an independent, private accrediting organization, such as the national committee on quality assurance, the national quality health council, the joint commission on accreditation of health care organizations, or the American accreditation healthcare commission/utilization review accreditation commission. The superintendent, upon review of the organization's accreditation process, may determine that such accreditation constitutes compliance by the health insuring corporation with the requirements of these sections.
Ohio Rev Code § 1751.822 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.822 | Cooperation With Utilization Review Program.

Effective: May 1, 2000|Latest Legislation:  House Bill 4 - 123rd General Assembly|Each participating provider or health care facility submitting a claim shall cooperate with the utilization review program of a health insuring corporation or utilization review organization and shall provide the health insuring corporation or its designee access to an enrollee's medical records during regular business hours, or copies of those records at a reasonable cost.
Ohio Rev Code § 1751.823 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.823 | Filing Certificate of Compliance.

Effective: May 1, 2000|Latest Legislation:  House Bill 4 - 123rd General Assembly|A health insuring corporation shall annually file a certificate with the superintendent of insurance certifying its compliance with sections 1751.77 to 1751.82 of the Revised Code.
Ohio Rev Code § 1751.83 (2021)
2021 Ohio Revised Code|Title 17 | Corporations-Partnerships|Chapter 1751 | Health Insuring Corporation Law|Section 1751.83 | Maintaining Internal Review System.

Effective: December 26, 2011|Latest Legislation:  House Bill 218 - 129th General Assembly|A health insuring corporation shall establish and maintain an internal review system that has been approved by the superintendent of insurance. The system shall provide for review by a clinical peer and include adequate and reasonable procedures for review and resolution of appeals from enrollees concerning adverse determinations made under section 1751.81 of the Revised Code, including procedures for verifying and reviewing appeals from enrollees whose medical conditions require expedited review. A health insuring corporation shall consider and provide a written response to each request for an internal review not later than thirty days after receipt of the request, except that if the seriousness of the enrollee's medical condition requires an expedited review, the health insuring corporation shall provide the written response not later than seven days after receipt of the request or in accordance with applicable preemptive federal laws or regulations. The response shall state the reason for the health insuring corporation's decision, inform the enrollee of the right to pursue a further review, and explain the procedures for initiating the review, including the time frames within which the enrollee must request the review, as specified in section 3922.02 of the Revised Code. Failure by a health insuring corporation to provide a written response within the time frames specified under this section shall be deemed a denial by the health insuring corporation for purposes of requesting an external review under Chapter 3922. of the Revised Code.If the health insuring corporation has denied, reduced, or terminated coverage for a health care service on the grounds that the service is not a service covered under the terms of the enrollee's policy, contract, or agreement, the response shall inform the enrollee of the right to request a review by the superintendent of insurance under Chapter 3922. of the Revised Code. If the health insuring corporation has denied, reduced, or terminated coverage for a health care service on the grounds that the service is not medically necessary, the response shall inform the enrollee of the right to request an external review under Chapter 3922. of the Revised Code.The health insuring corporation shall make available to the superintendent for inspection copies of all documents in the health insuring corporation's possession related to reviews conducted pursuant to this section, including medical records related to those reviews, and of responses, for three years following completion of the review.