reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5164.37 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.37 | Suspension of Provider Agreement Without Notice.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) The department of medicaid may suspend a medicaid provider's provider agreement without prior notice if the department has evidence that the provider presents a danger of immediate and serious harm to the health, safety, or welfare of medicaid recipients. The department also shall suspend all medicaid payments to the medicaid provider for services rendered, regardless of the date that the services were rendered, when the department suspends the provider agreement under this section. (B) If the department suspends a medicaid provider's provider agreement under this section, the department shall do both of the following: (1) Not later than five days after suspending the provider agreement, notify the medicaid provider of the suspension; (2) Not later than ten business days after suspending the provider agreement, notify the medicaid provider that the department intends to terminate the provider agreement. (C) The notice that the department provides to a medicaid provider under division (B)(2) of this section shall include the allegation that the provider presents a danger of immediate and serious harm to the health, safety, or welfare of medicaid recipients. It may also include other grounds for terminating the provider agreement. Section 5164.38 of the Revised Code applies to the termination of the provider agreement. (D) The suspension of a medicaid provider's provider agreement and medicaid payments shall cease at the earliest of the following: (1) The department's failure to provide a notice required by division (B) of this section by the time specified in that division; (2) The department rescinds its notice to terminate the provider agreement. (3) The department issues an order regarding the termination of the provider agreement pursuant to an adjudication conducted in accordance with Chapter 119. of the Revised Code. (E) This section does not limit the department's authority to suspend or terminate a provider agreement or medicaid payments to a medicaid provider under any other provision of the Revised Code.
Ohio Rev Code § 5164.39 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.39 | Hearing Not Required Unless Timely Requested.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|In any action taken by the department of medicaid under section 5164.38 or 5164.57 of the Revised Code or any other state statute governing the medicaid program that requires the department to give notice of an opportunity for a hearing in accordance with Chapter 119. of the Revised Code, if the department gives notice of the opportunity for a hearing but the medicaid provider or other entity subject to the notice does not request a hearing or timely request a hearing in accordance with section 119.07 of the Revised Code, the department is not required to hold a hearing. The medicaid director may proceed by issuing a final adjudication order in accordance with Chapter 119. of the Revised Code.
Ohio Rev Code § 5164.44 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.44 | Employee Status of Independent Provider.

Effective: March 23, 2016|Latest Legislation:  House Bill 56 - 131st General Assembly|(A) As used in this section: (1) "Aide services" means all of the following: (a) Home health aide services covered by the medicaid program as part of the home health services benefit pursuant to 42 C.F.R. 440.70(b)(2); (b) Home care attendant services covered by a participating medicaid waiver component, as defined in section 5166.30 of the Revised Code; (c) Any of the following covered by a home and community-based services medicaid waiver component: (i) Personal care aide services; (ii) Homemaker/personal care services; (iii) Community inclusion services. (2) "Independent provider" means an individual who personally provides aide services or nursing services under the medicaid program and is not employed by, under contract with, or affiliated with another entity that provides the services. (3) "Nursing services" means all of the following: (a) Nursing services covered by the medicaid program as part of the home health services benefit pursuant to 42 C.F.R. 440.70(b)(1); (b) Private duty nursing services, as defined in 42 C.F.R. 440.80, covered by the medicaid program; (c) Nursing services covered by a home and community-based services medicaid waiver component. (B) Notwithstanding any provision of the Revised Code to the contrary, an independent provider is not an employee of the state, or any political subdivision of the state, for any purpose under state law due to being an independent provider or any actions taken to become or remain an independent provider.
Ohio Rev Code § 5164.46 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.46 | Electronic Claims Submission Process; Electronic Fund Transfers.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) As used in this section, "electronic claims submission process" means any of the following: (1) Electronic interchange of data;(2) Direct entry of data through an internet-based mechanism implemented by the department of medicaid;(3) Any other process for the electronic submission of claims that is specified in rules adopted under section 5162.02 of the Revised Code.(B) Not later than January 1, 2013, and except as provided in division (C) of this section, each medicaid provider shall do both of the following:(1) Use only an electronic claims submission process to submit to the department of medicaid claims for medicaid payment for medicaid services provided to medicaid recipients;(2) Arrange to receive medicaid payment from the department by means of electronic funds transfer.(C) Division (B) of this section does not apply to any of the following:(1) A nursing facility;(2) An ICF/IID;(3) A medicaid managed care organization;(4) Any other medicaid provider or type of medicaid provider designated in rules adopted under section 5162.02 of the Revised Code.(D) The department shall not process a medicaid claim submitted on or after January 1, 2013, unless the claim is submitted through an electronic claims submission process in accordance with this section.
Ohio Rev Code § 5164.47 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.47 | Contracting for Review and Analysis, Quality Assurance and Quality Review.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) As used in this section, "OCHSPS" means the private, not-for-profit corporation known as the Ohio children's hospital solutions for patient safety, which was formed for the purpose of improving pediatric patient care in this state, which performs functions that are included within the functions of a peer review committee as defined in section 2305.25 of the Revised Code, and which consists of all of the following members: Akron children's hospital, Cincinnati children's hospital medical center, Cleveland clinic children's hospital, Dayton children's medical center, mercy children's hospital, nationwide children's hospital, rainbow babies & children's hospital, and Toledo children's hospital. (B) If, as authorized by section 5160.10 of the Revised Code, the medicaid director chooses to contract with a person to perform either or both of the following services, the director may contract with any qualified person, including OCHSPS, to perform the service or services on behalf of the department of medicaid:(1) Review and analyze claims for medicaid services provided to children in accordance with all state and federal laws governing the confidentiality of patient-identifying information;(2) Perform quality assurance and quality review functions, other than those described in division (B)(1) of this section, related to medicaid services provided to children.The functions specified in division (B)(2) of this section may include those recommended by the best evidence for advancing child health in Ohio now (BEACON) council.(C) If the director enters into a contract with OCHSPS for OCHSPS to perform either or both of the services described in division (B) of this section, OCHSPS shall, only for purposes of section 5160.12 of the Revised Code, be considered a public entity and the director shall seek federal financial participation for costs incurred by OCHSPS in performing the service or services.
Ohio Rev Code § 5164.471 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.471 | Summary Data Regarding Perinatal Services.

Effective: April 6, 2017|Latest Legislation:  Senate Bill 332 - 131st General Assembly|Not less than once each year and in accordance with all state and federal laws governing the confidentiality of patient-identifying information, the department of medicaid shall make summary data regarding perinatal services available on request to local organizations concerned with infant mortality reduction initiatives and recipients of grants administered by the division of family and community health services in the department of health.
Ohio Rev Code § 5164.48 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.48 | Medicaid Payments Made to Organization on Behalf of Providers.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The medicaid director may implement a system under which medicaid payments for medicaid services are made to an organization on behalf of medicaid providers. The system may not provide for an organization to receive an amount that exceeds, in aggregate, the amount the medicaid program would have paid directly to medicaid providers if not for this section.
Ohio Rev Code § 5164.55 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.55 | Final Fiscal Audits.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid may conduct final fiscal audits of medicaid providers in accordance with the applicable requirements set forth in federal laws and regulations and determine any amounts the provider may owe the state. When conducting final fiscal audits, the department shall consider generally accepted auditing standards, which include the use of statistical sampling.
Ohio Rev Code § 5164.56 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.56 | Lien for Amount Owed by Provider.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|Under the medicaid program, any amount determined to be owed the state by a final fiscal audit conducted pursuant to section 5164.55 of the Revised Code, upon the issuance of an adjudication order pursuant to Chapter 119. of the Revised Code that contains a finding that there is a preponderance of the evidence that a medicaid provider will liquidate assets or file bankruptcy in order to prevent payment of the amount determined to be owed the state, becomes a lien upon the real and personal property of the provider. Upon failure of the provider to pay the amount to the state, the medicaid director shall file notice of the lien, for which there shall be no charge, in the office of the county recorder of the county in which it is ascertained that the provider owns real or personal property. The director shall notify the provider by mail of the lien, but absence of proof that the notice was sent does not affect the validity of the lien. The lien is not valid as against the claim of any mortgagee, pledgee, purchaser, judgment creditor, or other lienholder of record at the time the notice is filed. If the provider acquires real or personal property after notice of the lien is filed, the lien shall not be valid as against the claim of any mortgagee, pledgee, subsequent bona fide purchaser for value, judgment creditor, or other lienholder of record to such after-acquired property unless the notice of lien is refiled after the property is acquired by the provider and before the competing lien attaches to the after-acquired property or before the conveyance to the subsequent bona fide purchaser for value.When the amount has been paid, the provider may record with the recorder notice of the payment. For recording such notice of payment, the recorder shall charge and receive from the provider a base fee of one dollar for services and a housing trust fund fee of one dollar pursuant to section 317.36 of the Revised Code.In the event of a distribution of the provider's assets pursuant to an order of any court under the law of this state including any receivership, assignment for benefit of creditors, adjudicated insolvency, or similar proceedings, amounts then or thereafter due the state under the medicaid program have the same priority as provided by law for the payment of taxes due the state and shall be paid out of the receivership trust fund or other such trust fund in the same manner as provided for claims for unpaid taxes due the state.If the attorney general finds after investigation that any amount due the state under the medicaid program is uncollectable, in whole or in part, the attorney general shall recommend to the director the cancellation of all or part of the claim. The director may thereupon effect the cancellation.
Ohio Rev Code § 5164.58 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.58 | Agency Action to Recover Overpayment to Provider.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) If a state agency that enters into a contract with the department of medicaid under section 5162.35 of the Revised Code identifies that a medicaid overpayment has been made to a medicaid provider, the state agency may commence actions to recover the overpayment on behalf of the department. (B) In recovering an overpayment pursuant to this section, a state agency shall comply with the following procedures:(1) The state agency shall attempt to recover the overpayment by notifying the medicaid provider of the overpayment and requesting voluntary repayment. Not later than five business days after notifying the medicaid provider, the state agency shall notify the department in writing of the overpayment. The state agency may negotiate a settlement of the overpayment and notify the department of the settlement. A settlement negotiated by the state agency is not valid and shall not be implemented until the department has given its written approval of the settlement.(2) If the state agency is unable to obtain voluntary repayment of an overpayment, the agency shall give the medicaid provider notice of an opportunity for a hearing in accordance with Chapter 119. of the Revised Code. If the medicaid provider timely requests a hearing in accordance with section 119.07 of the Revised Code, the state agency shall conduct the hearing to determine the legal and factual validity of the overpayment. On completion of the hearing, the state agency shall submit its hearing officer's report and recommendation and the complete record of proceedings, including all transcripts, to the medicaid director for final adjudication. The director may issue a final adjudication order in accordance with Chapter 119. of the Revised Code. The state agency shall pay any attorney's fees imposed under section 119.092 of the Revised Code. The department of medicaid shall pay any attorney's fees imposed under section 2335.39 of the Revised Code.(C) In any action taken by a state agency under this section that requires the agency to give notice of an opportunity for a hearing in accordance with Chapter 119. of the Revised Code, if the agency gives notice of the opportunity for a hearing but the medicaid provider subject to the notice does not request a hearing or timely request a hearing in accordance with section 119.07 of the Revised Code, the agency is not required to hold a hearing. The agency may request that the medicaid director issue a final adjudication order in accordance with Chapter 119. of the Revised Code.(D) This section does not preclude the department of medicaid from adjudicating a final fiscal audit under section 5164.38 of the Revised Code, recovering overpayments under section 5164.57 of the Revised Code, or making findings or taking other actions authorized by state statutes governing the medicaid program.
Ohio Rev Code § 5164.59 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.59 | Deduction of Incorrect Payments.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid may deduct from medicaid payments for medicaid services rendered by a medicaid provider any amounts the provider owes the state as the result of incorrect medicaid payments the department has made to the provider.
Ohio Rev Code § 5164.60 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.60 | Interest on Medicaid Provider Excess Payments.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|Any medicaid provider who, without intent, obtains payments under the medicaid program in excess of the amount to which the provider is entitled is liable for payment of interest on the amount of the excess payments for the period from the date on which payment was made to the date on which repayment is made to the state. The interest shall be paid at the average bank prime rate in effect on the first day of the calendar quarter during which the provider receives notice of the excess payment. The department of medicaid shall determine the average bank prime rate using statistical release H.15, "selected interest rates," a weekly publication of the federal reserve board, or any successor publication. If statistical release H.15, or its successor, ceases to contain the bank prime rate information or ceases to be published, the department shall request a written statement of the average bank prime rate from the federal reserve bank of Cleveland or the federal reserve board.
Ohio Rev Code § 5164.61 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.61 | Scope of Available Remedies for Recovery of Excess Payments.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The authority, under state and federal law, of the department of medicaid or a county department of job and family services to recover excess medicaid payments made to a medicaid provider is not limited by the availability of remedies under sections 5162.21 and 5162.23 of the Revised Code for recovering benefits paid on behalf of medicaid recipients.
Ohio Rev Code § 5164.70 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.70 | Limitations on Medicaid Payments for Services.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|Except as otherwise required by federal statute or regulation, no medicaid payment for any medicaid service provided by a hospital, nursing facility, or ICF/IID shall exceed the limits established under Subpart C of 42 C.F.R. Part 447.
Ohio Rev Code § 5164.71 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.71 | Payments for Freestanding Medical Laboratory Charges.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|Medicaid payments for freestanding medical laboratory charges shall not exceed the customary and usual fee for laboratory profiles.
Ohio Rev Code § 5164.72 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.72 | Limitations on Payments for Inpatient Hospital Care.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The number of days of inpatient hospital care for which a medicaid payment is made on behalf of a medicaid recipient to a hospital that is not paid under a diagnostic-related-group prospective payment system shall not exceed thirty days during a period beginning on the day of the recipient's admission to the hospital and ending sixty days after the termination of that hospital stay, except that the department of medicaid may make exceptions to this limitation. The limitation does not apply to children participating in the program for medically handicapped children established under section 3701.023 of the Revised Code.
Ohio Rev Code § 5164.721 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.721 | Claims by Freestanding Birthing Centers.

Effective: April 6, 2017|Latest Legislation:  Senate Bill 332 - 131st General Assembly|A hospital or freestanding birthing center that is a medicaid provider may submit to the department of medicaid or the department's fiscal agent a medicaid claim that is both of the following: (A) For a long-acting reversible contraceptive device that is covered by medicaid and provided to a medicaid recipient during the period after the recipient gives birth in the hospital or center and before the recipient is discharged from that location ; (B) Separate from another medicaid claim for other inpatient care the hospital or center provides to the medicaid recipient.
Ohio Rev Code § 5164.73 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.73 | Division of Payments Between Physician or Podiatrist and Nurse.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The division of any medicaid payment between a collaborating physician or podiatrist and a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner for services performed by the nurse shall be determined and agreed on by the nurse and collaborating physician or podiatrist. In no case shall the medicaid payment exceed the medicaid payment that the physician or podiatrist would have received had the physician or podiatrist provided the entire service.
Ohio Rev Code § 5164.74 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.74 | Reimbursement of Graduate Medical Education Costs.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The medicaid director shall adopt rules under section 5164.02 of the Revised Code governing the calculation and payment of, and the allocation of payments for, graduate medical education costs associated with medicaid services rendered to medicaid recipients. Subject to section 5164.741 of the Revised Code, the rules shall provide for payment of graduate medical education costs associated with medicaid services rendered to medicaid recipients, including recipients enrolled in a medicaid managed care organization, that the department of medicaid determines are allowable and reasonable. Last updated October 6, 2021 at 11:01 AM