Effective: January 1, 2017
Latest Legislation: House Bill 52 - 131st General Assembly
(A) A provider of medical services licensed, accredited, or certified under Chapter 3721., 3727., 4715., 4725., 4731., 4732., 4734., 4747., 4753., 4755., 4757., or 4779. of the Revised Code shall provide in writing, before products, services, or procedures are provided, a reasonable, good-faith estimate of all of the following for the provider's non-emergency products, services, or procedures:
(1) The amount the provider will charge the patient or the consumer's health plan issuer for the product, service, or procedure;
(2) The amount the health plan issuer intends to pay for the product, service, or procedure;
(3) The difference, if any, that the consumer or other party responsible for the consumer's care would be required to pay to the provider for the product, service, or procedure.
(B) Any health plan issuer contacted by a provider described in division (A) of this section in order for the provider to obtain information so that the provider can comply with division (A) of this section shall provide such information to the provider within a reasonable time of the provider's request.
(C) As used in this section, "health plan issuer" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offers to contract, to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefit plan, including a sickness and accident insurance company and a health insuring corporation. "Health plan issuer" also includes a managed care organization under contract with the department of medicaid and, if the services are to be provided on a fee-for-service basis, the Medicaid program.
(D) The medicaid director shall adopt rules, in accordance with Chapter 119. of the Revised Code, to carry out this section.
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.