reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5160.30 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.30 | Administrative Activities for Medical Assistance Programs.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) Except as provided in divisions (B) and (C) of this section, the department of medicaid may accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities for medical assistance programs. (B) The department may enter into agreements with one or more agencies of the federal government, the state, other states, and local governments of this or other states to accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities on behalf of the department with respect to medical assistance programs.(C) If federal law requires a face-to-face interview to complete an eligibility determination for a medical assistance program, the department shall not conduct the face-to-face interview.(D) Subject to division (C) of this section, if the department elects to accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities for a medical assistance program, both of the following apply:(1) An individual may apply for the medical assistance program to the department or an agency authorized by an agreement entered into under division (B) of this section to accept the individual's application;(2) The department is subject to federal statutes and regulations and state statutes and rules that require, permit, or prohibit an action regarding accepting applications, determining or redetermining eligibility, and performing related administrative activities for the medical assistance program.
Ohio Rev Code § 5160.31 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.31 | Appeals Regarding Determination of Eligibility for Medical Assistance Program.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) A medical assistance recipient may appeal a decision regarding the recipient's eligibility for a medical assistance program or services available to the recipient under a medical assistance program. (B) Regarding appeals authorized by this section, the department of medicaid shall do one or more of the following:(1) Administer an appeals process similar to the appeals process established under section 5101.35 of the Revised Code;(2) Contract with the department of job and family services pursuant to section 5162.35 of the Revised Code to provide for the department of job and family services to hear the appeals in accordance with section 5101.35 of the Revised Code;(3) Delegate authority to hear appeals to an exchange or exchange appeals entity.(C) If a medical assistance recipient files an appeal as authorized by this section, the department of medicaid may do either or both of the following:(1) Take corrective action regarding the matter being appealed before a hearing decision regarding the matter is issued;(2) If a hearing decision, administrative appeal decision, or court ruling is against the recipient, take action in favor of the recipient despite the contrary decision or ruling, unless, in the case of a court's ruling, the ruling prohibits the department from taking the action.
Ohio Rev Code § 5160.35 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.35 | Recovery of Medical Support Definitions.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|As used in sections 5160.35 to 5160.43 of the Revised Code: (A) "Information" means all of the following:(1) An individual's name, address, date of birth, and social security number;(2) The group or plan number, or other identifier, assigned by a third party to a policy held by an individual or a plan in which the individual participates and the nature of the coverage;(3) Any other data the medicaid director specifies in rules authorized by section 5160.43 of the Revised Code.(B) "Medical support" means support specified as support for the purpose of medical care by order of a court or administrative agency.(C)(1) Subject to division (C)(2) of this section, and except as provided in division (C)(3) of this section, "third party" means all of the following:(a) A person authorized to engage in the business of sickness and accident insurance under Title XXXIX of the Revised Code;(b) A person or governmental entity providing coverage for medical services or items to individuals on a self-insurance basis;(c) A health insuring corporation as defined in section 1751.01 of the Revised Code;(d) A group health plan as defined in 29 U.S.C. 1167;(e) A service benefit plan as referenced in 42 U.S.C. 1396a(a)(25);(f) A managed care organization;(g) A pharmacy benefit manager;(h) A third party administrator;(i) Any other person or governmental entity that is, by law, contract, or agreement, responsible for the payment or processing of a claim for a medical item or service for a medical assistance recipient.(2) Except when otherwise provided by the "Social Security Act," section 1862(b), 42 U.S.C. 1395y(b), a person or governmental entity listed in division (C)(1) of this section is a third party even if the person or governmental entity limits or excludes payments for a medical item or service in the case of a public assistance recipient.(3) "Third party" does not include the program for medically handicapped children established under section 3701.023 of the Revised Code.
Ohio Rev Code § 5160.371 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.371 | Disclosure of Third-Party Payer Information.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|In addition to the requirement of division (C) of section 5160.37 of the Revised Code to cooperate with the department of medicaid and county department of job and family services, a medical assistance recipient and the recipient's attorney, if any, shall cooperate with each medical provider of the recipient. Cooperation with a medical provider shall consist of disclosing to the provider all information the recipient and attorney, if any, possess that would assist the provider in determining each third party that is responsible for the payment or processing of a claim for medical assistance provided to the recipient. If disclosure is not made in accordance with this section, the recipient and the recipient's attorney, if any, are liable to reimburse the department or county department for the amount that would have been paid by a third party had the third party been disclosed to the provider by the recipient or the recipient's attorney.
Ohio Rev Code § 5160.38 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.38 | Assignment of Rights to Department.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) The application for, or enrollment in, a medical assistance program constitutes an automatic assignment of rights specified in division (B) of this section to the department of medicaid. This assignment includes the rights of the medical assistance recipient and also the rights of any other member of the assistance group for whom the recipient can legally make an assignment. (B) Pursuant to this section, a medical assistance recipient assigns to the department any rights to medical support available to the recipient or other members of the recipient's assistance group under an order of a court or administrative agency, and any rights to payments by a liable third party for the cost of medical assistance paid on behalf of the recipient or other members of the assistance group. The recipient shall cooperate with the department in obtaining such payments.Medicare benefits shall not be assigned pursuant to this section. Benefits assigned to the department by operation of this section are directly reimbursable to the department by liable third parties.(C) Refusal by a medical assistance recipient to cooperate in obtaining medical assistance paid for self or any other member of the recipient's assistance group renders the recipient ineligible for a medical assistance program, unless cooperation is waived by the department. Eligibility shall continue for any individual who cannot legally assign the individual's own rights and who would have been eligible for a medical assistance program but for the refusal to assign the individual's rights or to cooperate as required by this section by another person legally able to assign the individual's rights.(D) If a medical assistance recipient or any member of the recipient's assistance group becomes ineligible for a medical assistance program, the department shall restore to the recipient or assistance group member any future rights to benefits assigned under this section.
Ohio Rev Code § 5160.39 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.39 | Third-Party Cooperation Regarding Liability Information.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) A third party shall cooperate with the department of medicaid in identifying individuals for the purpose of establishing third party liability regarding medical assistance programs. (B) In furtherance of the requirement in division (A) of this section and to allow the department to determine any period that the individual or the individual's spouse or dependent may have been covered by the third party and the nature of the coverage, a third party shall provide, as the department so chooses, information or access to information, or both, in the third party's electronic data system on the department's request and in accordance with division (C) of this section.(C)(1) If the department chooses to receive information directly, the third party shall provide the information under all of the following circumstances:(a) In a medium, format, and manner prescribed in rules authorized by section 5160.43 of the Revised Code;(b) Free of charge;(c) Not later than the end of the thirtieth day after the department makes its request, unless a different time is agreed to by the director in writing.(2) If the department chooses to receive access to information, the third party shall provide access by a method prescribed in rules authorized by section 5160.43 of the Revised Code. In facilitating access, the department may enter into a trading partner agreement with the third party to permit the exchange of information via "ASC X 12N 270/271 Health Care Eligibility Benefit Inquiry and Response" transactions.(D) All of the following apply with respect to information provided by a third party to the department under this section:(1) The information is confidential and not a public record under section 149.43 of the Revised Code.(2) The release of information to the department is not to be considered a violation of any right of confidentiality or contract that the third party may have with covered persons including, but not limited to, contractees, beneficiaries, heirs, assignees, and subscribers.(3) The third party is immune from any liability that it may otherwise incur through its release of information to the department.The department shall limit its use of information gained from third parties to purposes directly connected with the administration of the medicaid program and the child support program authorized by Title IV-D of the "Social Security Act," 42 U.S.C. 651 et seq.(E) No third party shall disclose to other parties or make use of any information regarding medical assistance recipients that it obtains from the department, except in the manner provided in rules authorized by section 5160.43 of the Revised Code.
Ohio Rev Code § 5160.401 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.401 | Finality of Payments.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) A payment made by a third party under division (B)(5) of section 5160.40 of the Revised Code on a claim for payment of a medical item or service provided to a medical assistance recipient is final on the date that is two years after the payment was made to the department of medicaid or the applicable medicaid managed care organization. After a claim is final, the claim is subject to adjustment only if an action for recovery of an overpayment was commenced under division (B) of this section before the date the claim became final and the recovery is agreed to by the department or medicaid managed care organization under division (C) of this section.(B) If a third party determines that it overpaid a claim for payment, the third party may seek to recover all or part of the overpayment by filing a notice of its intent to seek recovery with the department or medicaid managed care organization, as applicable. The notice of recovery must be filed in writing before the date the payment is final. The notice must specify all of the following:(1) The full name of the medical assistance recipient who received the medical item or service that is the subject of the claim;(2) The date or dates on which the medical item or service was provided;(3) The amount allegedly overpaid and the amount the third party seeks to recover;(4) The claim number and any other number the department or medicaid managed care organization has assigned to the claim;(5) The third party's rationale for seeking recovery;(6) The date the third party made the payment and the method of payment used;(7) If payment was made by check, the check number;(8) Whether the third party would prefer to receive the amount being sought by obtaining a payment from the department or medicaid managed care organization, either by check or electronic means, or by offsetting the amount from a future payment to be made to the department or medicaid managed care organization.(C) If the department or appropriate medicaid managed care organization determines that a notice of recovery was filed before the claim for payment is final and agrees to the amount sought by the third party, the department or medicaid managed care organization, as applicable, shall notify the third party in writing of its determination and agreement. Recovery of the amount shall proceed in accordance with the method specified by the third party pursuant to division (B)(8) of this section.
Ohio Rev Code § 5160.41 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.41 | Excluded Considerations for Third-Party Medical Assistance.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|No third party shall consider whether an individual is eligible for or enrolled in a medical assistance program when either of the following applies: (A) The individual seeks to obtain a policy or enroll in a plan or program operated or administered by the third party;(B) The individual, or a person or governmental entity on the individual's behalf, seeks payment for a medical item or service provided to the individual.
Ohio Rev Code § 5160.42 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.42 | Sanctions Against Third Parties for Violations.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) If a third party violates section 5160.39, 5160.40, or 5160.41 of the Revised Code, a governmental entity that is responsible for issuing a license, certificate of authority, registration, or approval that authorizes the third party to do business in this state may impose a fine against the third party or deny, revoke, or terminate the third party's license, certificate, registration, or approval to do business in this state. The governmental entity shall determine which sanction is to be imposed. All actions to impose the sanction shall be taken in accordance with Chapter 119. of the Revised Code. (B) In addition to the sanctions that may be imposed under division (A) of this section for a violation of section 5160.39, 5160.40, or 5160.41 of the Revised Code, the attorney general may petition a court of common pleas to enjoin the violation.
Ohio Rev Code § 5160.43 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.43 | Adoption of Rules Regarding Recovery of Costs.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) The medicaid director may adopt rules under section 5160.02 of the Revised Code to implement sections 5160.35 to 5160.43 of the Revised Code, including rules that specify what constitutes cooperating with efforts to obtain support or payments, or medical assistance payments, and when cooperation may be waived. (B) The department shall adopt rules under section 5160.02 of the Revised Code to do all of the following:(1) For purposes of the definition of "information" in division (A) of section 5160.35 of the Revised Code, any data other than the data specified in that division that should be included in the definition.(2) For purposes of division (C)(1)(a) of section 5160.39 of the Revised Code, the medium, format, and manner in which a third party must provide information to the department.(3) For purposes of division (C)(2) of section 5160.39 of the Revised Code, the method by which a third party must provide the department with access to information.(C) Rules authorized by division (A) of this section may be adopted in accordance with section 111.15 of the Revised Code. Rules authorized by division (B) of this section shall be adopted in accordance with Chapter 119. of the Revised Code.
Ohio Rev Code § 5160.46 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.46 | Authorization Form.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) For the purposes of section 5160.45 of the Revised Code, an authorization shall be made on a form that uses language understandable to the average person and contains all of the following: (1) A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion;(2) The name or other specific identification of the person or class of persons authorized to make the requested use or disclosure;(3) The name or other specific identification of the person or government entity to which the information may be released;(4) A description of each purpose of the requested use or disclosure of the information;(5) The date on which the authorization expires or an event related either to the individual who is the subject of the request or to the purposes of the requested use or disclosure, the occurrence of which will cause the authorization to expire;(6) A statement that the information used or disclosed pursuant to the authorization may be disclosed by the recipient of the information and may no longer be protected from disclosure;(7) The signature of the individual or the individual's authorized representative and the date on which the authorization was signed;(8) If signed by an authorized representative, a description of the representative's authority to act for the individual;(9) A statement of the individual or authorized representative's right to prospectively revoke the written authorization in writing, along with either of the following:(a) A description of how the individual or authorized representative may revoke the authorization;(b) If the department of medicaid has established a privacy notice that contains a description of how the individual or authorized representative may revoke the authorization, a reference to the privacy notice.(10) A statement that treatment, payment, enrollment, or eligibility for a medical assistance program cannot be conditioned on signing the authorization unless the authorization is necessary for determining eligibility for the program.(B) An authorization for the release of information regarding a medical assistance recipient to the recipient's attorney under division (D)(3) of section 5160.45 of the Revised Code may include a provision specifically authorizing the release of the recipient's electronic health records, if any, in accordance with rules authorized by section 5160.48 or 5160.481 of the Revised Code.(C) When an individual requests information pursuant to section 5160.45 of the Revised Code regarding the individual's enrollment in a medical assistance program and does not wish to provide a statement of purpose, the statement "at request of the individual" is a sufficient description for purposes of division (A)(4) of this section.
Ohio Rev Code § 5160.47 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.47 | Membership in the Public Assistance Reporting Information System and Other Multistate Cooperatives.

Effective: July 1, 2019|Latest Legislation:  House Bill 119 - 132nd General Assembly|(A) The department of medicaid shall do both of the following:(1) Enter into any necessary agreements with the United States department of health and human services and neighboring states to join and participate as an active member in the public assistance reporting information system;(2) Explore joining other multistate cooperatives, such as the national accuracy clearinghouse, to identify individuals enrolled in public assistance programs outside of this state.(B) The department may disclose information regarding a medical assistance recipient to the extent necessary to participate as an active member in the public assistance reporting information system or other multistate cooperative.
Ohio Rev Code § 5160.471 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5160 | Medical Assistance Programs|Section 5160.471 | Review to Determine Eligibility for Federal Military-Related Health Care Benefits.

Effective: March 23, 2016|Latest Legislation:  Senate Bill 10 - 131st General Assembly|(A) As used in this section:"Federal military-related health care benefits" means any of the health care benefits provided by the United States department of defense or the United States department of veterans affairs to current or former service members and their eligible dependents, including the benefits provided through the programs known as tricare and champva.(B) (1) The department of medicaid shall review information in the public assistance reporting information system to determine whether an individual who is a medical assistance recipient may be eligible for federal military-related health care benefits. If the department determines that the individual may be eligible for federal military-related health care benefits, it shall notify the individual of the potential eligibility and encourage the individual to contact the veterans service commission in the county in which the individual resides for assistance in applying for the benefits. The department shall provide the appropriate contact information to the individual.