Health insuring corporation means a corporation, as defined in division (H) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan.
Health insuring corporation means an entity that holds a certificate of authority under Chapter 1751. of the Revised Code. "Health insuring corporation" includes wholly owned subsidiaries of a health insuring corporation.
Health insuring corporation. As defined by ORC section 1751.01(H), a corporation, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan. Healthchek – As defined in OAC rule 5160-1-14, comprehensive preventive health services available to individuals under 21 years of age who are enrolled in Medicaid, otherwise known as early and periodic screening, diagnostic, and treatment (EPSDT) services. HealthTrack – Database operated by the Ohio Department of Medicaid that tracks member and provider complaints. HUB – Network of community-based organizations that hire and train community health workers to reach out to those at greatest risk, identify their risk factors, and assure that they connect to medical, social, and behavioral health services to reduce their risk. In Lieu of Services – Consistent with the requirements in 42 CFR 438.3(e)(2), services the MCO may cover for members that are in lieu of services covered under the Ohio Medicaid state plan and that ODM determines are medically appropriate and cost-effective substitutes for the covered service under the Ohio Medicaid state plan. Incident – As defined in OAC rule 5160-44-05, an alleged, suspected, or actual event that is not consistent with the routine care of, and/or service delivery to an individual that may have a negative impact on the health and welfare of the individual. Incidents include, but are not limited to, the following types of events: abuse, neglect, exploitation, misappropriation greater than $500, and accidental/unnatural death. Indian – Any individual defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, under 42 CFR 136.12. Indian Health Care Provider – A health care program operated by the Indian Health Service or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (otherwise known as an I/T/U) as these terms are defined in Section 4 of the Indian Health Care Improvement Act (25 USC 1603). Institution for Mental Disease (IMD) – As defined in 42 CFR 435.1010, a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosi...
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Health insuring corporation means a corporation, as defined in division (H) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for,
Health insuring corporation means a corporation formed under Revised Code Chapter 1701. (general corporation law) or 1702. (nonprofit corporation law), or the similar laws of another state, that pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan (R.C. 1751.01(N)).
Health insuring corporation means a corporation, as defined in division
Health insuring corporation. ” means a corporation, as defined in division (G) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a
Health insuring corporation means a corporation, as defined in division (H) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health
Health insuring corporation. As defined by ORC section 1751.01(H), a corporation, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan. HealthTrack – Database operated by the Ohio Department of Medicaid that tracks member and provider complaints. HUB – Network of community-based organizations that hire and train community health workers to reach out to those at greatest risk, identify their risk factors, and assure that they connect to medical, social, and behavioral health services to reduce their risk. In Lieu of Services – Consistent with the requirements in 42 CFR 438.3(e)(2), services the OhioRISE Plan may cover for members that are in lieu of services covered under the Ohio Medicaid state plan and that ODM determines are medically appropriate and cost effective substitutes for the covered service under the Ohio Medicaid state plan. Incident – As defined in OAC 5160-44-05, an alleged, suspected, or actual event that is not consistent with the routine care of, and/or service delivery to a member. Indian – Any individual defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, under 42 CFR 136.12. Limited English Proficiency (LEP) – Eligible individual or member who does not speak English as their primary language and who has a limited ability to read, write, speak, or understand English. Managed Care Organization (MCO) – An entity that meets the requirements of 42 CFR 438.2 and is a health insuring corporation (HIC) licensed in the state of Ohio that enters into a managed care provider agreement with ODM. Managed Care Entities (MCEs) – Entities that include managed care organizations, statewide pharmacy benefits manager, and the OhioRISE Plan.
Health insuring corporation. As defined by ORC section 1751.01(H), a corporation, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan. HealthTrack – Database operated by the Ohio Department of Medicaid that tracks member and provider complaints. HUB – Network of community-based organizations that hire and train community health workers to reach out to those at greatest risk, identify their risk factors, and assure that they connect to medical, social, and behavioral health services to reduce their risk. In Lieu of Services – Consistent with the requirements in 42 CFR 438.3(e)(2), services the OhioRISE Plan may cover for members that are in lieu of services covered under the Ohio Medicaid state plan and that ODM determines are medically appropriate and cost-effective substitutes for the covered service under the Ohio Medicaid state plan. Incident – As defined in OAC 5160-44-05, an alleged, suspected, or actual event that is not consistent with the routine care of, and/or service delivery to a member. Independent Review Organization (IRO) - An entity that conducts independent external reviews of adverse benefit determinations. Indian – Any individual defined at 25 USC 1603(13), 1603(28), or 1679(a), or who has been determined eligible as an Indian, under 42 CFR 136.12. Individual Crisis and Safety Plan - As defined in OAC 5160-59-01, a plan developed through care coordination and the Child and Family Team (CFT) to determine specific steps to ensure child and family safety and reduce the risk of harm in the home and community. The Individual Crisis and Safety Plan should include individualized, trauma-informed, interventions and de-escalation strategies. The Individual Crisis and Safety Plan encompasses what is also referred to as a behavior support plan, which details when an individual's intensive behavior warrants the use of restraints, seclusion, or restrictive intervention to ensure the safety of the individual and those with whom they interact. For members with behaviors that pose safety concerns for the member or others, the interventions and de-escalation strategies should be designed with the goal of p...