Effective: October 17, 2019
Latest Legislation: House Bill 166 - 133rd General Assembly
(A) The medicaid director shall enter into a contract with one or more persons to receive and process, on the director's behalf, requests for medicaid recipient or claims payment data, data from reports of audits conducted under section 5165.109 of the Revised Code, or extracts or analyses of any of the foregoing data made by persons who intend to use the items prepared pursuant to the requests for commercial or academic purposes.
(B) At a minimum, a contract entered into under this section shall do both of the following:
(1) Authorize the contracting person to engage in the activities described in division (A) of this section for compensation, which must be stated as a percentage of the fees paid by persons who are provided the items;
(2) Require the contracting person to charge for an item prepared pursuant to a request a fee in an amount equal to one hundred two per cent of the cost the department of medicaid incurs in making the data used to prepare the item available to the contracting person.
(C) Except as required by federal or state law and subject to division (E) of this section, both of the following conditions apply with respect to a request for data described in division (A) of this section:
(1) The request shall be made through a person who has entered into a contract with the medicaid director under this section.
(2) An item prepared pursuant to the request may be provided to the department of medicaid and is confidential and not subject to disclosure under section 149.43 or 1347.08 of the Revised Code.
(D) The medicaid director shall use fees the director receives pursuant to a contract entered into under this section to pay obligations specified in contracts entered under this section. Any money remaining after the obligations are paid shall be deposited in the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code.
(E) This section does not apply to requests for medicaid recipient or claims payment data, data from reports of audits conducted under section 5165.109 of the Revised Code, or extracts or analyses of any of the foregoing data that are for any of the following purposes:
(1) Treatment of medicaid recipients;
(2) Payment of medicaid claims;
(3) Establishment or management of medicaid third party liability pursuant to sections 5160.35 to 5160.43 of the Revised Code;
(4) Compliance with the terms of an agreement the medicaid director enters into for purposes of administering the medicaid program.
Structure Ohio Revised Code
Chapter 5162 | Medicaid and Medicaid Funds
Section 5162.01 | Definitions.
Section 5162.02 | Rules for Implementation of Chapter.
Section 5162.021 | Adoption of Rules by Other State Agencies.
Section 5162.022 | Director's Rules Binding.
Section 5162.03 | Administration of Medicaid Program.
Section 5162.031 | Powers of Director.
Section 5162.04 | No State Cause of Action to Enforce Federal Laws.
Section 5162.05 | Implementation of Medicaid Program.
Section 5162.06 | Components Requiring Federal Approval or Funding.
Section 5162.07 | Federal Approval for Permissive Components Not Required.
Section 5162.10 | Review of Medicaid Program; Corrective Action; Sanctions.
Section 5162.11 | Contract for Data Collection and Warehouse Functions Assessment.
Section 5162.12 | Contracts for the Management of Medicaid Data Requests.
Section 5162.13 | Annual Report.
Section 5162.131 | Semiannual Reports on Controlling Increase in Costs.
Section 5162.132 | Annual Report Outlining Efforts to Minimize Fraud, Waste, and Abuse.
Section 5162.133 | Annual Program Report; Distribution; Contents.
Section 5162.134 | Annual Report of Integrated Care Delivery System Evaluation.
Section 5162.135 | Infant Mortality Scorecard.
Section 5162.1310 | Evaluation of Success of Expansion Eligibility Group.
Section 5162.15 | Information Required Where Annual Medicaid Payments Exceed $5 Million.
Section 5162.16 | Reporting Fraud, Waste, or Abuse.
Section 5162.20 | Cost-Sharing Requirements.
Section 5162.21 | Medicaid Estate Recovery Program.
Section 5162.211 | Lien Against Property of Recipient or Spouse as Part of Estate Recovery Program.
Section 5162.212 | Certification of Amounts Due Under Estate Recovery Program; Collection.
Section 5162.22 | Transfer of Personal Needs Allowance Account.
Section 5162.23 | Recovering Benefits Incorrectly Paid.
Section 5162.24 | Recovering Health Care Costs Provided to Child.
Section 5162.30 | Medicaid Administrative Claiming Program.
Section 5162.31 | Local Funds Expended for Administration of the Healthy Start Component.
Section 5162.32 | Contracts With Political Subdivisions to Pay Nonfederal Share.
Section 5162.35 | Contracts for Administration of Components.
Section 5162.36 | Medicaid School Component.
Section 5162.361 | Claim by Qualified Medicaid School Provider.
Section 5162.362 | Federal Financial Participation for Medicaid School Claims.
Section 5162.363 | Administration of Medicaid School Component.
Section 5162.364 | Adoption of Rules for Medicaid School Component.
Section 5162.365 | Responsibility for Repaying Overpayments.
Section 5162.366 | Referrals for Certain Services Under the Medicaid School Program.
Section 5162.37 | Contract Approval Required.
Section 5162.40 | Retaining or Collecting Percentage of Federal Financial Participation.
Section 5162.41 | Retaining or Collecting Percentage of Supplemental Payment.
Section 5162.50 | Health Care-Federal Fund.
Section 5162.52 | Health Care/medicaid Support and Recoveries Fund.
Section 5162.56 | Health Care Special Activities Fund.
Section 5162.65 | Refunds and Reconciliation Fund.
Section 5162.66 | Residents Protection Fund.
Section 5162.70 | Reforms to Medicaid Program.
Section 5162.71 | Implementation of Systems to Improve Health and Reduce Health Disparities.
Section 5162.72 | Strategies to Address Social Determinants of Health.
Section 5162.73 | Dental Services for Pregnant Medicaid Recipients.
Section 5162.75 | Notification of Veteran Services.
Section 5162.80 | Good Faith Estimates for Charges and Payments.