5112.17 Providing basic, medically necessary hospital-level services to individuals who are residents.
(A) As used in this section:
(1)”Federal poverty guideline” means the official poverty guideline as revised annually by the United States secretary of health and human services in accordance with section 673 of the “Community Service Block Grant Act,” 95 Stat. 511 (1981), 42 U.S.C.A. 9902, as amended, for a family size equal to the size of the family of the person whose income is being determined.
(2) “Third-party payer” means any private or public entity or program that may be liable by law or contract to make payment to or on behalf of an individual for health care services. “Third-party payer” does not include a hospital.
(B) Each hospital that receives funds distributed under sections 5112.01 to 5112.21 of the Revised Code shall provide, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of this state, are not recipients of the medical assistance program, and whose income is at or below the federal poverty guideline. Recipients of disability financial assistance provided under Chapter 5115. of the Revised Code qualify for services under this section. The director of job and family services shall adopt rules under section 5112.03 of the Revised Code specifying the hospital services to be provided under this section.
(C) Nothing in this section shall be construed to prevent a hospital from requiring an individual to apply for eligibility under the medical assistance program before the hospital processes an application under this section. Hospitals may bill any third-party payer for services rendered under this section. Hospitals may bill the medical assistance program, in accordance with Chapter 5111. of the Revised Code and the rules adopted under that chapter, for services rendered under this section if the individual becomes a recipient of the program. Hospitals may bill individuals for services under this section if all of the following apply:
(1) The hospital has an established post-billing procedure for determining the individual’s income and canceling the charges if the individual is found to qualify for services under this section.
(2) The initial bill, and at least the first follow-up bill, is accompanied by a written statement that does all of the following:
(a) Explains that individuals with income at or below the federal poverty guideline are eligible for services without charge;
(b) Specifies the federal poverty guideline for individuals and families of various sizes at the time the bill is sent;
(c) Describes the procedure required by division (C)(1) of this section.
(3) The hospital complies with any additional rules the department adopts under section 5112.03 of the Revised Code.
Notwithstanding division (B) of this section, a hospital providing care to an individual under this section is subrogated to the rights of any individual to receive compensation or benefits from any person or governmental entity for the hospital goods and services rendered.
(D) Each hospital shall collect and report to the department, in the form and manner prescribed by the department, information on the number and identity of patients served pursuant to this section.
(E) This section applies beginning May 22, 1992, regardless of whether the department has adopted rules specifying the services to be provided. Nothing in this section alters the scope or limits the obligation of any governmental entity or program, including the program awarding reparations to victims of crime under sections 2743.51 to 2743.72 of the Revised Code and the program for medically handicapped children established under section 3701.023 of the Revised Code, to pay for hospital services in accordance with state or local law.
Amended by 128th General Assembly File No. 9, HB 1, § 101.01, eff. 10/16/2009.
5112.17 Providing basic, medically necessary hospital-level services to individuals who are residents.
(A) As used in this section:
(1)”Federal poverty guideline” means the official poverty guideline as revised annually by the United States secretary of health and human services in accordance with section 673 of the “Community Service Block Grant Act,” 95 Stat. 511 (1981), 42 U.S.C.A. 9902, as amended, for a family size equal to the size of the family of the person whose income is being determined.
(2) “Third-party payer” means any private or public entity or program that may be liable by law or contract to make payment to or on behalf of an individual for health care services. “Third-party payer” does not include a hospital.
(B) Each hospital that receives funds distributed under sections 5112.01 to 5112.21 of the Revised Code shall provide, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of this state, are not recipients of the medical assistance program, and whose income is at or below the federal poverty guideline. Recipients of disability financial assistance provided under Chapter 5115. of the Revised Code qualify for services under this section. The director of job and family services shall adopt rules under section 5112.03 of the Revised Code specifying the hospital services to be provided under this section.
(C) Nothing in this section shall be construed to prevent a hospital from requiring an individual to apply for eligibility under the medical assistance program before the hospital processes an application under this section. Hospitals may bill any third-party payer for services rendered under this section. Hospitals may bill the medical assistance program, in accordance with Chapter 5111. of the Revised Code and the rules adopted under that chapter, for services rendered under this section if the individual becomes a recipient of the program. Hospitals may bill individuals for services under this section if all of the following apply:
(1) The hospital has an established post-billing procedure for determining the individual’s income and canceling the charges if the individual is found to qualify for services under this section.
(2) The initial bill, and at least the first follow-up bill, is accompanied by a written statement that does all of the following:
(a) Explains that individuals with income at or below the federal poverty guideline are eligible for services without charge;
(b) Specifies the federal poverty guideline for individuals and families of various sizes at the time the bill is sent;
(c) Describes the procedure required by division (C)(1) of this section.
(3) The hospital complies with any additional rules the department adopts under section 5112.03 of the Revised Code.
Notwithstanding division (B) of this section, a hospital providing care to an individual under this section is subrogated to the rights of any individual to receive compensation or benefits from any person or governmental entity for the hospital goods and services rendered.
(D) Each hospital shall collect and report to the department, in the form and manner prescribed by the department, information on the number and identity of patients served pursuant to this section.
(E) This section applies beginning May 22, 1992, regardless of whether the department has adopted rules specifying the services to be provided. Nothing in this section alters the scope or limits the obligation of any governmental entity or program, including the program awarding reparations to victims of crime under sections 2743.51 to 2743.72 of the Revised Code and the program for medically handicapped children established under section 3701.023 of the Revised Code, to pay for hospital services in accordance with state or local law.
Amended by 128th General Assembly File No. 9, HB 1, § 101.01, eff. 10/16/2009.
5112.17 Providing basic, medically necessary hospital-level services to individuals who are residents.
(A) As used in this section:
(1)”Federal poverty guideline” means the official poverty guideline as revised annually by the United States secretary of health and human services in accordance with section 673 of the “Community Service Block Grant Act,” 95 Stat. 511 (1981), 42 U.S.C.A. 9902, as amended, for a family size equal to the size of the family of the person whose income is being determined.
(2) “Third-party payer” means any private or public entity or program that may be liable by law or contract to make payment to or on behalf of an individual for health care services. “Third-party payer” does not include a hospital.
(B) Each hospital that receives funds distributed under sections 5112.01 to 5112.21 of the Revised Code shall provide, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of this state, are not recipients of the medical assistance program, and whose income is at or below the federal poverty guideline. Recipients of disability financial assistance provided under Chapter 5115. of the Revised Code qualify for services under this section. The director of job and family services shall adopt rules under section 5112.03 of the Revised Code specifying the hospital services to be provided under this section.
(C) Nothing in this section shall be construed to prevent a hospital from requiring an individual to apply for eligibility under the medical assistance program before the hospital processes an application under this section. Hospitals may bill any third-party payer for services rendered under this section. Hospitals may bill the medical assistance program, in accordance with Chapter 5111. of the Revised Code and the rules adopted under that chapter, for services rendered under this section if the individual becomes a recipient of the program. Hospitals may bill individuals for services under this section if all of the following apply:
(1) The hospital has an established post-billing procedure for determining the individual’s income and canceling the charges if the individual is found to qualify for services under this section.
(2) The initial bill, and at least the first follow-up bill, is accompanied by a written statement that does all of the following:
(a) Explains that individuals with income at or below the federal poverty guideline are eligible for services without charge;
(b) Specifies the federal poverty guideline for individuals and families of various sizes at the time the bill is sent;
(c) Describes the procedure required by division (C)(1) of this section.
(3) The hospital complies with any additional rules the department adopts under section 5112.03 of the Revised Code.
Notwithstanding division (B) of this section, a hospital providing care to an individual under this section is subrogated to the rights of any individual to receive compensation or benefits from any person or governmental entity for the hospital goods and services rendered.
(D) Each hospital shall collect and report to the department, in the form and manner prescribed by the department, information on the number and identity of patients served pursuant to this section.
(E) This section applies beginning May 22, 1992, regardless of whether the department has adopted rules specifying the services to be provided. Nothing in this section alters the scope or limits the obligation of any governmental entity or program, including the program awarding reparations to victims of crime under sections 2743.51 to 2743.72 of the Revised Code and the program for medically handicapped children established under section 3701.023 of the Revised Code, to pay for hospital services in accordance with state or local law.
Amended by 128th General Assembly File No. 9, HB 1, § 101.01, eff. 10/16/2009.
