reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5164.09 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.09 | Equivalent Coverage for Orally and Intravenously Administered Cancer Medications.

Effective: January 1, 2015|Latest Legislation:  Senate Bill 99 - 130th General Assembly|(A) Except as provided in division (C) of this section, the medicaid program shall cover prescribed, orally administered cancer medications on at least the same basis that it covers intraveneously administered or injected cancer medications. In implementing this section, the department of medicaid shall not institute cost-sharing requirements under section 5162.20 of the Revised Code for prescribed, orally administered cancer medications that are greater than any cost-sharing requirements instituted under that section for intraveneously administered or injected cancer medications. (B) Division (A) of this section does not preclude the department from requiring a medicaid recipient to obtain prior authorization before a prescribed, orally administered cancer medication is dispensed to the recipient.(C) This section shall not be implemented during a fiscal year if the medicaid director determines that this section's implementation would cause the costs of the medicaid program's coverage of prescribed drugs to increase by more than one per cent over such costs for the most recent previous fiscal year for which the amount of such costs is known.
Ohio Rev Code § 5164.091 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.091 | Coverage for Opioid Analgesics.

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 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) With respect to the medicaid program's coverage of prescribed drugs, the department of medicaid shall apply 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 care 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 department 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 the department 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 § 5164.10 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.10 | Coverage of Tobacco Cessation Medications and Services.

Effective: September 18, 2020|Latest Legislation:  House Bill 11 - 133rd General Assembly|(A) The medicaid program shall cover both of the following, subject to division (C) of this section: (1) All tobacco cessation medications approved by the United States food and drug administration; (2) All forms of tobacco cessation services recommended by the United States preventive services task force, including individual, group, and telephone counseling and any combination thereof. (B) The department of medicaid shall not impose any of the following conditions with respect to the coverage required by this section: (1) Counseling requirements for tobacco cessation medications; (2) Except as provided in division (B)(4) of this section, limits on the duration of services, including annual or lifetime limits on the number of covered attempts to quit using tobacco; (3) Cost-sharing requirements under section 5162.20 of the Revised Code; (4) Prior authorization requirements, step therapy protocols as defined in section 5164.7512 of the Revised Code, or any other utilization management requirements, except that prior authorization may be required for either of the following: (a) Treatment that exceeds the duration recommended in the United States public health service clinical practice guidelines on treating tobacco use and dependence;  (b) Services associated with more than two attempts to quit using tobacco within a twelve-month period. (C) The director of health shall adopt rules in accordance with Chapter 119. of the Revised Code that establish standards and procedures for approving the forms of tobacco cessation medications and services that must be covered under this section. The rules shall also establish standards and procedures for updating the approved forms of tobacco cessation medications and services that must be covered under this section when the approved forms are modified by the United States food and drug administration, United States public health service, or United States preventive services task force. (D) With respect to the coverage required by this section, the department of medicaid shall do both of the following: (1) Inform medicaid recipients about the coverage; (2) Market the coverage to Medicaid recipients.
Ohio Rev Code § 5164.14 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.14 | Medicaid Coverage for Health Care Service Provided by Pharmacist.

Effective: December 16, 2020|Latest Legislation:  House Bill 203 - 133rd General Assembly|The medicaid program may cover a health care service that a pharmacist provides to a medicaid recipient in accordance with Chapter 4729. of the Revised Code, including any of the following services: (A) Managing drug therapy under a consult agreement pursuant to section 4729.39 of the Revised Code;  (B) Administering immunizations in accordance with section 4729.41 of the Revised Code;  (C) Administering drugs in accordance with section 4729.45 of the Revised Code.
Ohio Rev Code § 5164.15 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.15 | Mental Health Services.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) As used in this section: (1) "Community mental health services provider or facility" means a community mental health services provider or facility that has its community mental health services certified by the department of mental health and addiction services under section 5119.36 of the Revised Code or by the department of job and family services under section 5103.03 of the Revised Code.(2) "Mental health professional" means a person qualified to work with mentally ill persons under the standards established by the director of mental health and addiction services pursuant to section 5119.36 of the Revised Code.(B) The medicaid program may cover the following mental health services when provided by community mental health services providers or facilities:(1) Outpatient mental health services, including, but not limited to, preventive, diagnostic, therapeutic, rehabilitative, and palliative interventions rendered to individuals in an individual or group setting by a mental health professional in accordance with a plan of treatment appropriately established, monitored, and reviewed;(2) Partial-hospitalization mental health services rendered by persons directly supervised by a mental health professional;(3) Unscheduled, emergency mental health services of a kind ordinarily provided to persons in crisis when rendered by persons supervised by a mental health professional;(4) Assertive community treatment and intensive home-based mental health services.(C) The department of medicaid shall enter into a separate contract with the department of mental health and addiction services under section 5162.35 of the Revised Code with regard to the mental health services the medicaid program covers pursuant to this section.
Ohio Rev Code § 5164.16 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.16 | Coverage of One or More State Plan Home and Community-Based Services.

Effective: September 18, 2020|Latest Legislation:  House Bill 11 - 133rd General Assembly|The medicaid program may cover one or more state plan home and community-based services that the department of medicaid selects for coverage. A medicaid recipient of any age may receive a state plan home and community-based service if the recipient has countable income not exceeding two hundred twenty-five per cent of the federal poverty line, has a medical need for the service, and meets all other eligibility requirements for the service specified in rules adopted under section 5164.02 of the Revised Code. The rules may not require a medicaid recipient to undergo a level of care determination to be eligible for a state plan home and community-based service.
Ohio Rev Code § 5164.17 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.17 | Medicaid Coverage of Tobacco Cessation Services.

Effective: September 18, 2020|Latest Legislation:  House Bill 11 - 133rd General Assembly|The medicaid program may cover tobacco cessation services in addition to the services that must be covered under section 5164.10 of the Revised Code or may exclude coverage of additional tobacco cessation services.
Ohio Rev Code § 5164.20 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.20 | Medicaid Not to Cover Drugs for Erectile Dysfunction.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The medicaid program shall not cover prescribed drugs for treatment of erectile dysfunction.
Ohio Rev Code § 5164.25 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.25 | Recipient With Developmental Disability Who Is Eligible for Medicaid Case Management Services.

Effective: October 12, 2016|Latest Legislation:  House Bill 158 - 131st General Assembly|The departments of developmental disabilities and medicaid may approve, reduce, deny, or terminate a medicaid service included in the individual service plan developed for a medicaid recipient with a developmental disability who is eligible for medicaid case management services. If either department approves, reduces, denies, or terminates a service, that department shall timely notify the medicaid recipient that the recipient may appeal pursuant to section 5160.31 of the Revised Code.
Ohio Rev Code § 5164.26 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.26 | Healthcheck Component.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall establish a combination of written and oral methods designed to provide information about healthcheck to all persons eligible for the program or their parents or guardians. The department shall ensure that its methods of providing information are effective. Each entity that distributes or accepts applications for medicaid shall prominently display a notice that complies with the methods of providing information about healthcheck established under this section.
Ohio Rev Code § 5164.29 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.29 | Revised Medicaid Provider Enrollment System.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|Not later than December 31, 2018, the department of medicaid shall develop and implement revisions to the system by which persons and government entities become and remain medicaid providers so that there is a single system of records for the system and the persons and government entities do not have to submit duplicate data to the state to become or remain medicaid providers for any component or aspect of a component of the medicaid program, including a component or aspect of a component administered by another state agency or political subdivision pursuant to a contract entered into under section 5162.35 of the Revised Code. The departments of aging, developmental disabilities, and mental health and addiction services shall participate in the development of the revisions and shall utilize the revised system.
Ohio Rev Code § 5164.291 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.291 | Provider Credentialing Committee.

Effective: March 23, 2022|Latest Legislation:  House Bill 122 - 134th General Assembly|The department of medicaid shall establish a credentialing program that includes a credentialing committee to review the competence, professional conduct, and quality of care provided by medicaid providers. Any activities performed by the credentialing committee shall be considered activities of a peer review committee of a health care entity and shall be subject to sections 2305.25 to 2305.253 of the Revised Code. The medicaid director may adopt rules under section 5164.02 of the Revised Code as necessary to implement this section. Any rules adopted shall be consistent with the requirements that apply to medicare advantage organizations under 42 C.F.R. 422.204. Last updated January 27, 2022 at 3:52 PM
Ohio Rev Code § 5164.30 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.30 | Provider Agreement With Department Required.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|No person or government entity may participate in the medicaid program as a medicaid provider without a valid provider agreement with the department of medicaid.
Ohio Rev Code § 5164.301 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.301 | Medicaid Provider Agreements for Physician Assistants.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) As used in this section, "group practice" has the same meaning as in section 4731.65 of the Revised Code. (B) The department of medicaid shall establish a process by which a physician assistant may enter into a provider agreement.(C)(1) Subject to division (C)(2) of this section, a claim for medicaid payment for a medicaid service provided by a physician assistant to a medicaid recipient may be submitted by the physician assistant who provided the service or the physician, group practice, clinic, or other health care facility that employs the physician assistant.(2) A claim for medicaid payment may be submitted by the physician assistant who provided the service only if the physician assistant has a valid provider agreement. When submitting the claim, the physician assistant shall use only the medicaid provider number the department has assigned to the physician assistant.
Ohio Rev Code § 5164.31 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.31 | Funding for Implementing the Provider Screening Requirements.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) For the purpose of raising funds necessary to pay the expenses of implementing the provider screening requirements of subpart E of 42 C.F.R. Part 455 and except as provided in division (B) of this section, the department of medicaid shall collect an application fee from a medicaid provider before doing any of the following:(1) Entering into a provider agreement with a medicaid provider that seeks initial enrollment as a provider;(2) Entering into a provider agreement with a former medicaid provider that seeks re-enrollment as a provider;(3) Revalidating a medicaid provider's continued enrollment as a provider.(B) The department is not to collect an application fee from a medicaid provider that is exempt from paying the fee under 42 C.F.R. 455.460(a).(C) The application fees shall be deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code. Application fees are nonrefundable when collected in accordance with 42 C.F.R. 455.460(a).(D) The medicaid director shall adopt rules under section 5164.02 of the Revised Code as necessary to implement this section, including a rule establishing the amount of the application fee to be collected under this section. The amount of the application fee shall not be set at an amount that is more than necessary to pay for the expenses of implementing the provider screening requirements.
Ohio Rev Code § 5164.32 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.32 | Expiration of Medicaid Provider Agreements.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) Each medicaid provider agreement shall expire not later than five years from its effective date. If a provider agreement entered into before the effective date of this amendment does not have a time limit, the department of medicaid shall convert the agreement to a provider agreement with a time limit. (B) The medicaid director shall adopt rules under section 5164.02 of the Revised Code as necessary to implement this section. The rules shall be consistent with subpart E of 42 C.F.R. Part 455 and include a process for revalidating medicaid providers' continued enrollments as providers. All of the following apply to the revalidation process:(1) The department shall refuse to revalidate a provider's provider agreement when the provider fails to file a complete application for revalidation within the time and in the manner required under the revalidation process.(2) If a provider files a complete application for revalidation within the time and in the manner required under the revalidation process, but the provider agreement expires before the department acts on the application or before the effective date of the department's decision on the application, the provider, subject to division (B)(3) of this section, may continue operating under the terms of the expired provider agreement until the effective date of the department's decision.(3) If a provider continues operating under the terms of an expired provider agreement pursuant to division (B)(2) of this section and the department denies the provider's application for revalidation, medicaid payments shall not be made for services or items the provider provides during the period beginning on the date the provider agreement expired and ending on the effective date of a subsequent provider agreement, if any, the department enters into with the provider.
Ohio Rev Code § 5164.33 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5164 | Medicaid State Plan Services|Section 5164.33 | Denying, Terminating, and Suspending Provider Agreements.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) The medicaid director may do the following for any reason permitted or required by federal law and when the director determines that the action is in the best interests of medicaid recipients or the state: (1) Deny, refuse to revalidate, suspend, or terminate a provider agreement;(2) Exclude an individual, provider of services or goods, or other entity from participation in the medicaid program.(B) No individual, provider, or entity excluded from participation in the medicaid program under this section shall do any of the following:(1) Own, or provide services to, any other medicaid provider or risk contractor;(2) Arrange for, render, or order services for medicaid recipients during the period of exclusion;(3) During the period of exclusion, receive direct payments under the medicaid program or indirect payments of medicaid funds in the form of salary, shared fees, contracts, kickbacks, or rebates from or through any other medicaid provider or risk contractor.(C) An individual, provider, or entity excluded from participation in the medicaid program under this section may request a reconsideration of the exclusion. The director shall adopt rules under section 5164.02 of the Revised Code governing the process for requesting a reconsideration.(D) Nothing in this section limits the applicability of section 5164.38 of the Revised Code to a medicaid provider.