reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5167.241 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.241 | State Pharmacy Benefit Manager Contract; Payment Arrangements.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A)(1) Medicaid managed care organizations shall use the state pharmacy benefit manager selected under section 5167.24 of the Revised Code pursuant to the terms of the master contract entered into under that section. All payment arrangements between the department of medicaid, medicaid managed care organizations, and the state pharmacy benefit manager shall comply with state and federal statutes, regulations adopted by the centers for medicare and medicaid services, and any other agreement between the department and the centers for medicare and medicaid services. The director may change a payment arrangement in order to comply with state and federal statutes, regulations adopted by the centers for medicare and medicaid services, or any other agreement between the department and the centers for medicare and medicaid services.
Ohio Rev Code § 5167.243 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.243 | Quarterly Reports.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) The state pharmacy benefit manager shall provide to the medicaid director a written quarterly report containing the following information from the immediately preceding quarter: (1) The prices that the state pharmacy benefit manager negotiated for prescribed drugs under the care management system. The price must include any rebates the state pharmacy benefit manager received from the drug manufacturer; (2) The prices the state pharmacy benefit manager paid to pharmacies for prescribed drugs; (3) Any rebate amounts the state pharmacy benefit manager passed on to individual pharmacies; (4) The percentage of savings in drug prices that are passed on to participants in the care management system; (5) The information described in division (C) of section 5167.24 of the Revised Code; (6) Any other information required by the director. (B) The director may ask the state pharmacy benefit manager to provide additional information as necessary and shall collect other clinical data from the state pharmacy benefit manager as the director sees fit. (C) At the time of contract execution, renewal, or modification, the department shall modify the reporting requirements under its medicaid managed care organization contracts as necessary to meet the requirements of this section.
Ohio Rev Code § 5167.244 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.244 | Violations; Penalty.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|No person shall violate the terms of the master state pharmacy benefit manager contract under section 5167.24 of the Revised Code or section 5167.241 of the Revised Code. Whoever violates those sections is subject to a civil penalty in an amount to be determined by the medicaid director.
Ohio Rev Code § 5167.245 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.245 | Appeals Process.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The medicaid director shall establish an appeals process by which pharmacies may appeal to the department of medicaid any disputes relating to the maximum allowable cost set by the state pharmacy benefit manager for a prescribed drug. All pharmacies participating in the care management system shall use the appeals process to resolve any disputes relating to the maximum allowable cost set by the state pharmacy benefit manager.
Ohio Rev Code § 5167.26 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.26 | Records for Determining Costs.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|For the purpose of determining the amount the department of medicaid pays hospitals under section 5168.09 of the Revised Code and the amount of disproportionate share hospital payments paid by the medicare program pursuant to section 1915 of the "Social Security Act," 42 U.S.C. 1396n, a medicaid managed care organization shall keep detailed records for each hospital with which it contracts, including records regarding the cost to the hospital of providing hospital services for the organization, payments made by the organization to the hospital for the services, utilization of hospital services by the organization's enrollees, and other utilization data required by the department.
Ohio Rev Code § 5167.30 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.30 | Managed Care Performance Payment Program.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A)(1) The department of medicaid shall establish a managed care performance payment program. Under the program, the department may provide payments to medicaid managed care organizations that meet performance standards established by the department.(2) In establishing performance standards, the department may consult any of the following:(a) Any quality measurements developed under the pediatric quality measures program established pursuant to the "Social Security Act," section 1139A, 42 U.S.C. 1320b-9a;(b) Any core set of adult health quality measures for medicaid eligible adults used for purposes of the "Social Security Act," section 1139A, 42 U.S.C. 1320b-9b, and any adult health quality used for purposes of the medicaid quality measurement program when the program is established under that section of the "Social Security Act";(c) The most recent healthcare effectiveness data and information set and quality measurement tool established by the national committee for quality assurance.(3) The standards that must be met to receive the payments may be specified in the contract the department enters into with a medicaid managed care organization.(4) If a medicaid managed care organization meets the performance standards established by the department, the department shall make one or more performance payments to the organization. The amount of each performance payment, the number of payments, and the schedule for making the payments shall be established by the department. The payments shall be discontinued if the department determines that the organization no longer meets the performance standards. The department shall not make or discontinue payments based on any performance standard that has been in effect as part of the organization's contract for less than six months.(B) For purposes of the program, the department shall establish an amount that is to be withheld each time a premium payment is made to a medicaid managed care organization. The amount shall be established as a percentage of each premium payment. The percentage shall be the same for all medicaid managed care organizations. The sum of all withholdings under this division shall not exceed five per cent of the total of all premium payments made to all medicaid managed care organizations.Each medicaid managed care organization shall agree to the withholding as a condition of receiving or maintaining its provider agreement with the department.When the amount is established and each time the amount is modified thereafter, the department shall certify the amount to the director of budget and management and begin withholding the amount from each premium the department pays to a medicaid managed care organization.
Ohio Rev Code § 5167.31 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.31 | Financial Incentive Awards.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid may provide financial incentive awards to medicaid managed care organizations that meet or exceed performance standards specified in provider agreements or rules adopted by the medicaid director under section 5167.02 of the Revised Code. The department may specify in a contract with a medicaid managed care organization the amounts of financial incentive awards, methodology for distributing awards, types of awards, and standards for administration by the department.
Ohio Rev Code § 5167.32 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.32 | Improving Integrity of Care Management System.

Effective: September 29, 2015|Latest Legislation:  House Bill 64 - 131st General Assembly|Not later than July 1, 2016, the department of medicaid shall implement strategies to improve the integrity of the care management system, including strategies to do both of the following:(A) Increase the department's oversight of medicaid managed care organizations;(B) Provide incentives for identifying fraud, waste, and abuse in the care management system.
Ohio Rev Code § 5167.33 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.33 | Strategies Regarding Payment to Providers.

Effective: September 29, 2015|Latest Legislation:  House Bill 64 - 131st General Assembly|(A) Not later than July 1, 2018, each medicaid managed care organization shall implement strategies that base payments to providers on the value received from the providers' services, including their success in reducing waste in the provision of the services. Not later than July 1, 2020, each medicaid managed care organization shall ensure that at least fifty per cent of the aggregate net payments it makes to providers are based on the value received from the providers' services.The department of medicaid may measure a medicaid managed care organization's compliance with this section based on the actions of the organization, the providers in the organization's provider panel, the organization's subcontractors, or any combination of the organization, providers, and subcontractors.(B) The medicaid director shall adopt rules under section 5167.02 of the Revised Code as necessary to implement this section, including rules that specify how all of the following are to be determined:(1) The value received from a provider's services;(2) A provider's success in reducing waste in the provision of services;(3) The percentage of a medicaid managed care organization's aggregate net payments to providers that are based on the value received from the providers' services.
Ohio Rev Code § 5167.34 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.34 | Immunity From Liability.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|A medicaid managed care organization, its officers, employees, or other persons associated with the managed care organization are not liable in a civil action for damages or other relief for furnishing information to the department of medicaid regarding potential fraud, waste, or abuse in the medicaid program.
Ohio Rev Code § 5167.40 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.40 | Appointment of Temporary Manager.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall appoint a temporary manager for a medicaid managed care organization if the department determines that the medicaid managed care organization has repeatedly failed to meet substantive requirements specified in the "Social Security Act," sections 1903(m) and 1932, 42 U.S.C. 1396b(m) and 1396u-2; or 42 C.F.R. 438 Part I. The appointment of a temporary manager does not preclude the department from imposing other sanctions available to the department against the medicaid managed care organization. The medicaid managed care organization shall pay all costs of having the temporary manager perform the temporary manager's duties, including all costs the temporary manager incurs in performing those duties. If the temporary manager incurs costs or liabilities on behalf of the medicaid managed care organization, the medicaid managed care organization shall pay those costs and be responsible for those liabilities.The appointment of a temporary manager is not subject to Chapter 119. of the Revised Code, but the managed care organization may request a reconsideration of the appointment. Reconsiderations shall be requested and conducted in accordance with rules the medicaid director shall adopt under section 5167.02 of the Revised Code.The appointment of a temporary manager does not cause the medicaid managed care organization to lose the right to appeal, in accordance with Chapter 119. of the Revised Code, any proposed termination or any decision not to revalidate the medicaid managed care organization's provider agreement or the right to initiate the sale of the medicaid managed care organization or its assets.
Ohio Rev Code § 5167.41 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.41 | Disenrolling Some or All Medicaid Recipients From Mco Plan Offered by a Managed Care Organization.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The department of medicaid may disenroll some or all medicaid recipients from a medicaid MCO plan offered by a medicaid managed care organization if the department proposes to terminate or not to renew the contract entered into under section 5167.10 of the Revised Code and determines that the recipients' access to medically necessary services is jeopardized by the proposal to terminate or not to renew the contract. The disenrollment is not subject to Chapter 119. of the Revised Code, but the medicaid managed care organization may request a reconsideration of the disenrollment. Reconsiderations shall be requested and conducted in accordance with rules the medicaid director shall adopt under section 5167.02 of the Revised Code. The request for, or conduct of, a reconsideration regarding a proposed disenrollment shall not delay the disenrollment.
Ohio Rev Code § 5167.45 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.45 | Information About Medicaid Recipients' Races, Ethnicities, and Primary Languages.

Effective: April 6, 2017|Latest Legislation:  Senate Bill 332 - 131st General Assembly|The department of medicaid shall include information about medicaid recipients' races, ethnicities, and primary languages in data the department shares with medicaid managed care organizations. Medicaid managed care organizations shall include this information in the data the organizations share with providers.
Ohio Rev Code § 5167.47 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.47 | Compliance With Federal Mental Health and Addiction Parity Laws.

Effective: March 24, 2021|Latest Legislation:  Senate Bill 284 - 133rd General Assembly|(A) When contracting with a medicaid managed care organization, the department of medicaid shall require the medicaid managed care organization to provide to medicaid enrollees the same benefits and rights as required under division (B) of section 3902.36 of the Revised Code. (B) The medicaid director shall do both of the following: (1) Implement and enforce division (B) of section 3902.36 of the Revised Code with respect to medicaid managed care organizations; (2) Enforce, monitor compliance with, and ensure continued compliance with this section. (C) The director may adopt rules under section 5167.02 of the Revised Code as necessary to carry out the provisions of this section.
Ohio Rev Code § 5168.02 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5168 | Hospital Care Assurance Program; Health Care Franchise Permit Fees|Section 5168.02 | [Repealed Effective 10/16/2023] Adoption of Rules.

Effective: December 31, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) The medicaid director shall adopt rules in accordance with Chapter 119. of the Revised Code for the purpose of administering sections 5168.01 to 5168.14 of the Revised Code, including rules that do all of the following:(1) Define as a "disproportionate share hospital" any hospital included under the "Social Security Act," section 1923(b), 42 U.S.C. 1396r-4(b), and any other hospital the director determines appropriate;(2) Prescribe the form for submission of cost reports under section 5168.05 of the Revised Code;(3) Establish, in accordance with division (A) of section 5168.06 of the Revised Code, the assessment rate or rates to be applied to hospitals under that section;(4) Establish schedules for hospitals to pay installments on their assessments under section 5168.06 of the Revised Code and for governmental hospitals to pay installments on their intergovernmental transfers under section 5168.07 of the Revised Code;(5) Establish procedures to notify hospitals of adjustments made under division (B)(2)(b) of section 5168.06 of the Revised Code in the amount of installments on their assessment;(6) Establish procedures to notify hospitals of adjustments made under division (D) of section 5168.08 of the Revised Code in the total amount of their assessment and to adjust for the remainder of the program year the amount of the installments on the assessments;(7) Establish, in accordance with section 5168.09 of the Revised Code, the methodology for paying hospitals under that section.The director shall consult with hospitals when adopting the rules required by divisions (A)(4) and (5) of this section in order to minimize hospitals' cash flow difficulties.(B) Rules adopted under this section may provide that "total facility costs" excludes costs associated with any of the following:(1) Medicaid recipients;(2) Recipients of the program for medically handicapped children established under section 3701.023 of the Revised Code;(3) Medicare beneficiaries;(4) Recipients of Title V of the "Social Security Act," 42 U.S.C. 701 et seq.;(5) Any other category of costs deemed appropriate by the director in accordance with Title XIX of the "Social Security Act," 42 U.S.C. 1396 et seq., and the rules adopted under that title. Last updated September 8, 2021 at 5:07 PM
Ohio Rev Code § 5168.03 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5168 | Hospital Care Assurance Program; Health Care Franchise Permit Fees|Section 5168.03 | [Repealed Effective 10/16/2023] Provisions Dependent on Assessment as Permissible Health Care-Related Tax.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The requirements of sections 5168.06 to 5168.09 of the Revised Code apply only as long as the United States centers for medicare and medicaid services determines that the assessment imposed under section 5168.06 of the Revised Code is a permissible health care-related tax pursuant to the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w). Whenever the department of medicaid is informed that the assessment is an impermissible health care-related tax, the department shall promptly refund to each hospital the amount of money currently in the hospital care assurance program fund created by section 5168.11 of the Revised Code that has been paid by the hospital under section 5168.06 or 5168.07 of the Revised Code, plus any investment earnings on that amount. Last updated September 8, 2021 at 5:07 PM
Ohio Rev Code § 5168.04 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5168 | Hospital Care Assurance Program; Health Care Franchise Permit Fees|Section 5168.04 | [Repealed Effective 10/16/2023] Program Year Basis of Operation.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall operate the hospital care assurance program established by sections 5168.01 to 5168.14 of the Revised Code on a program year basis. The department shall complete all program requirements on or before the thirtieth day of September each year. Last updated September 8, 2021 at 5:08 PM
Ohio Rev Code § 5168.05 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5168 | Hospital Care Assurance Program; Health Care Franchise Permit Fees|Section 5168.05 | [Repealed Effective 10/16/2023] Submitting Financial Statement and Cost Report.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) Except as provided in division (C) of this section, each hospital, on or before the first day of July of each year or at a later date approved by the medicaid director, shall submit to the department of medicaid a financial statement for the preceding calendar year that accurately reflects the income, expenses, assets, liabilities, and net worth of the hospital, and accompanying notes. A hospital that has a fiscal year different from the calendar year shall file its financial statement within one hundred eighty days of the end of its fiscal year or at a later date approved by the director. The financial statement shall be prepared by an independent certified public accountant and reflect an official audit report prepared in a manner consistent with generally accepted accounting principles. The financial statement shall, to the extent that the hospital has sufficient financial records, show bad debt and charity care separately from courtesy care and contractual allowances. (B) Except as provided in division (C) of this section, each hospital, within one hundred eighty days after the end of the hospital's cost reporting period, shall submit to the department a cost report in a format prescribed in rules adopted under section 5168.02 of the Revised Code. The department shall grant a hospital an extension of the one hundred eighty day period if the United States centers for medicare and medicaid services extends the date by which the hospital must submit its cost report for the hospital's cost reporting period. (C) The director may adopt rules under section 5168.02 of the Revised Code specifying financial information that must be submitted by hospitals for which no financial statement or cost report is available. The rules shall specify deadlines for submitting the information. Each such hospital shall submit the information specified in the rules not later than the deadline specified in the rules. Last updated September 8, 2021 at 5:08 PM