Enact the Medicaid Savings Act

As Introduced

136th
General Assembly

Regular
Session
S. B. No. 386

2025-2026

Senators Blessing, Liston

To
amend sections 126.021, 126.024, 173.19, 1751.03, 3701.741, 3901.81,
3902.70, 3903.14, 3903.42, 3959.01, 3963.06, 4121.50, 4729.20,
4729.49, 4729.80, 4729.84, 4729.86, 5160.01, 5160.34, 5160.37,
5160.371, 5160.40, 5162.01, 5162.021, 5162.13, 5162.1310, 5162.73,
5164.01, 5164.38, 5164.46, 5164.74, 5164.751, 5166.01, 5166.40,
5166.405, 5166.406, 5168.75, 5168.76, 5739.01, and 5739.03; to amend,
for the purpose of adopting a new section number as indicated in
parentheses, section 5162.73 (5162.74); to enact new section 5162.73;
and to repeal sections 1751.271, 3901.815, 3903.421, 5164.741,
5167.01, 5167.02, 5167.03, 5167.031, 5167.04, 5167.05, 5167.051,
5167.09, 5167.10, 5167.101, 5167.103, 5167.11, 5167.12, 5167.122,
5167.123, 5167.13, 5167.14, 5167.15, 5167.16, 5167.17, 5167.171,
5167.173, 5167.18, 5167.20, 5167.201, 5167.21, 5167.22, 5167.221,
5167.24, 5167.241, 5167.243, 5167.244, 5167.245, 5167.26, 5167.30,
5167.31, 5167.32, 5167.33, 5167.34, 5167.35, 5167.40, 5167.41,
5167.45, 5167.47, and 5739.051 of the Revised Code
to
eliminate the care management system from the Medicaid program and to
name this act the Medicaid Savings Act.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
sections 126.021, 126.024, 173.19, 1751.03, 3701.741, 3901.81,
3902.70, 3903.14, 3903.42, 3959.01, 3963.06, 4121.50, 4729.20,
4729.49, 4729.80, 4729.84, 4729.86, 5160.01, 5160.34, 5160.37,
5160.371, 5160.40, 5162.01, 5162.021, 5162.13, 5162.1310, 5162.73,
5164.01, 5164.38, 5164.46, 5164.74, 5164.751, 5166.01, 5166.40,
5166.405, 5166.406, 5168.75, 5168.76, 5739.01, and 5739.03 be
amended; section 5162.73 (5162.74) be amended for the purpose of
adopting a new section number as indicated in parentheses; and new
section 5162.73 of the Revised Code be enacted to read as follows:

Sec.
126.021.
The
director of budget and management, as part of the submission to the
governor under section 126.02 of the Revised Code, shall prepare and
submit to the governor not later than the first day of January
preceding the convening of the general assembly a medicaid caseload
and expenditure forecast report, prepared in consultation with the
department of medicaid. For each component identified in divisions
(A) to (Q) of this section, the report shall include proposed,
actual, or estimated medicaid program data for each fiscal year of
the proposed budget biennium and for each fiscal year of the current
budget biennium. If determined useful, the directors of budget and
management and medicaid may choose to include additional years of
data for components of the report.

The
report shall include all of the following:

(A)
A complete budget for the medicaid program delineated by the agency
administering each component of the program, fund, appropriation
item, and whether the spending is for services or administration;

(B)
A summary of medicaid service spending by eligibility group and
subgroup and service delivery system;

(C)
A detailed mapping of the summary spending provided in division (B)
of this section into individual appropriation items and including
state and federal shares of each appropriation item;

(D)
A complete description of each policy proposal, including assumed
start date and cost projection delineated by fiscal year,
appropriation item, state and federal shares, eligibility group and
subgroup, and service delivery system;

(E)
The medicaid caseload delineated by eligibility group and subgroup
and service delivery system;

(F)

The
percentage of total medicaid enrollment that is comprised of medicaid
recipients enrolled under the care management system established
under section 5167.03 of the Revised Code and the percentage of total
medicaid spending that the care management system comprises;

(G)

A
detailed accounting of the care management system component of the
medicaid budget by eligibility group and subgroup, including
spending, member months, and per member per month capitation rates;

(H)
(G)

A detailed accounting of the fee-for-service component of the
medicaid budget by eligibility group and subgroup, including
spending, member months, and per member per month costs;

(I)
(H)

Historical spending data by service delivery system, medicaid
provider and program, including at least the following provider
categories: hospital, pharmacy, waiver, nursing, home health care,
professional medical and clinic, nursing facility, behavioral health
care, and intermediate care facility for individuals with
intellectual disabilities;

(J)
(I)

A detailed accounting of the medicare buy-in and medicare Part D
components of the medicaid budget by eligibility group and subgroup,
including spending, average monthly premiums, and average rates;

(K)
(J)

A summary of projected spending for each fiscal year delineated by
forecast component and by baseline and policy proposals;

(L)
(K)

A detailed calculation demonstrating the effect of a hypothetical
one-dollar increase in medicaid home and community-based services
wages for direct care providers for each fiscal year, delineated by
provider, appropriation item, and state and federal shares;

(M)
(L)

A detailed calculation demonstrating the effect of a hypothetical one
percentage point increase in provider franchise fee revenue for each
fiscal year, for each of the fees imposed under sections 5168.21,
5168.41, and 5168.76 of the Revised Code;

(N)
(M)

A detailed calculation demonstrating the effect of a hypothetical
one-dollar increase in nursing facility and intermediate care
facility for individuals with intellectual disabilities per medicaid
day payment rates;

(O)
(N)

A detailed explanation of how the governor's medicaid budget
recommendations satisfy the requirements of section 5162.70 of the
Revised Code;

(P)
(O)

The most recent report required under section 5162.70 of the Revised
Code;

(Q)
(P)

Any other information the director of budget and management or the
medicaid director deems to be useful to facilitate a better
understanding of the governor's medicaid budget recommendations.

Sec.
126.024.
Beginning
with the state budget that is introduced following
the
effective date of this section
September
30, 2025
,
and subsequent state budgets thereafter, the director of budget and
management, in consultation with the medicaid director, shall request
and propose multiple medicaid health care services general revenue
fund appropriation items. At a minimum, the directors shall propose a
separate general revenue fund appropriation item for the different
health care services included in the medicaid program, including all
of the following:

(A)

Services
provided under the care management system;

(B)

Nursing
facility services;

(C)
(B)

Hospital services;

(D)
(C)

Behavioral health services;

(E)
(D)

Services provided under medicaid waiver components administered by
the department of aging;

(F)
(E)

Prescription drug services;

(G)
(F)

Physician services;

(H)
(G)

Services provided under the Ohio home care waiver program;

(I)
(H)

Services provided under medicaid waiver components administered by
the department of developmental disabilities;

(J)
(I)

Services provided under the medicaid waiver component known as the
Ohio resilience through integrated systems and excellence (OhioRISE)
waiver;

(K)
(J)

Any other medicaid health care services that the directors determine
should have a separate general revenue fund appropriation item.

Sec.
173.19.
(A)
The office of the state long-term care ombudsman program, through the
state long-term care ombudsman and the regional long-term care
ombudsman programs, shall receive, investigate, and attempt to
resolve complaints made by residents, recipients, sponsors, long-term
care providers, or any person acting on behalf of a resident or
recipient, relating to either of the following:

(1)
The health, safety, welfare, or civil rights of a resident or
recipient or any violation of a resident's rights described in
sections 3721.10 to 3721.17 of the Revised Code;

(2)
Any action or inaction or decision by any of the following that may
adversely affect the health, safety, welfare, or rights of a resident
or recipient: a long-term care provider or a representative of a
long-term care provider
;
a medicaid managed care organization, as defined in section 5167.01
of the Revised Code; a government entity;

or a private social service agency.

(B)
The department of aging shall adopt rules in accordance with Chapter
119. of the Revised Code regarding the handling of complaints
received under this section, including procedures for conducting
investigations of complaints. The rules shall include procedures to
ensure that no representative of the office investigates any
complaint involving a long-term care provider with which the
representative was once employed or associated.

The
state ombudsman and regional programs shall establish procedures for
handling complaints consistent with the department's rules.
Complaints shall be dealt with in accordance with the procedures
established under this division.

(C)
The office of the state long-term care ombudsman program may decline
to investigate any complaint if it determines any of the following:

(1)
That the complaint is frivolous, vexatious, or not made in good
faith;

(2)
That the complaint was made so long after the occurrence of the
incident on which it is based that it is no longer reasonable to
conduct an investigation;

(3)
That an adequate investigation cannot be conducted because of
insufficient funds, insufficient staff, lack of staff expertise, or
any other reasonable factor that would result in an inadequate
investigation despite a good faith effort;

(4)
That an investigation by the office would create a real or apparent
conflict of interest.

(D)
If a regional long-term care ombudsman program declines to
investigate a complaint, it shall refer the complaint to the state
long-term care ombudsman.

(E)
Each complaint to be investigated by a regional program shall be
assigned to a representative of the office of the state long-term
care ombudsman program. If the representative determines that the
complaint is valid, the representative shall assist the parties in
attempting to resolve it. If the representative is unable to resolve
it, the representative shall refer the complaint to the state
ombudsman.

In
order to carry out the duties of sections 173.14 to 173.28 of the
Revised Code, a representative has the right to private communication
with residents and their sponsors and access to long-term care
facilities, including the right to tour resident areas unescorted and
the right to tour facilities unescorted as reasonably necessary to
the investigation of a complaint. Access to facilities shall be
during reasonable hours or, during investigation of a complaint, at
other times appropriate to the complaint.

When
community-based long-term care services are provided at a location
other than the recipient's home, a representative has the right to
private communication with the recipient and the recipient's sponsors
and access to the community-based long-term care site, including the
right to tour the site unescorted. Access to the site shall be during
reasonable hours or, during the investigation of a complaint, at
other times appropriate to the complaint.

(F)
The state ombudsman shall determine whether complaints referred to
the ombudsman under division (D) or (E) of this section warrant
investigation. The ombudsman's determination in this matter is final.

(G)
No long-term care provider or other entity, no person employed by a
long-term care provider or other entity, and no other individual
shall do either of the following:

(1)
Knowingly deny a representative of the office of the state long-term
care ombudsman program the right to private communication or access
described in division (E) of this section;

(2)
Engage in willful interference.

As
used in division (G)(2) of this section, "willful interference"
means any action or inaction that is intended to prevent, interfere
with, or impede a representative of the office of the state long-term
care ombudsman program from exercising any of the rights or
performing any of the duties of an ombudsman set forth in sections
173.14 to 173.28 of the Revised Code.

Sec.
1751.03.
(A)
Each application for a certificate of authority under this chapter
shall be verified by an officer or authorized representative of the
applicant, shall be in a format prescribed by the superintendent of
insurance, and shall set forth or be accompanied by the following:

(1)
A certified copy of the applicant's articles of incorporation and all
amendments to the articles of incorporation;

(2)
A copy of any regulations adopted for the government of the
corporation, any bylaws, and any similar documents, and a copy of all
amendments to these regulations, bylaws, and documents. The corporate
secretary shall certify that these regulations, bylaws, documents,
and amendments have been properly adopted or approved.

(3)
A list of the names, addresses, and official positions of the persons
responsible for the conduct of the applicant, including all members
of the board, the principal officers, and the person responsible for
completing or filing financial statements with the department of
insurance, accompanied by a completed original biographical affidavit
and release of information for each of these persons on forms
acceptable to the department;

(4)
A full and complete disclosure of the extent and nature of any
contractual or other financial arrangement between the applicant and
any provider or a person listed in division (A)(3) of this section,
including, but not limited to, a full and complete disclosure of the
financial interest held by any such provider or person in any health
care facility, provider, or insurer that has entered into a financial
relationship with the health insuring corporation;

(5)
A description of the applicant, its facilities, and its personnel,
including, but not limited to, the location, hours of operation, and
telephone numbers of all contracted facilities;

(6)
The applicant's projected annual enrollee population over a
three-year period;

(7)
A clear and specific description of the health care plan or plans to
be used by the applicant, including a description of the proposed
providers, procedures for accessing care, and the form of all
proposed and existing contracts relating to the administration,
delivery, or financing of health care services;

(8)
A copy of each type of evidence of coverage and identification card
or similar document to be issued to subscribers;

(9)
A copy of each type of individual or group policy, contract, or
agreement to be used;

(10)
The schedule of the proposed contractual periodic prepayments or
premium rates, or both, accompanied by appropriate supporting data;

(11)
A financial plan which provides a three-year projection of operating
results, including the projected expenses, income, and sources of
working capital;

(12)
The enrollee complaint procedure to be utilized as required under
section 1751.19 of the Revised Code;

(13)
A description of the procedures and programs to be implemented on an
ongoing basis to assure the quality of health care services delivered
to enrollees, including, if applicable, a description of a quality
assurance program complying with the requirements of sections 1751.73
to 1751.75 of the Revised Code;

(14)
A statement describing the geographic area or areas to be served, by
county;

(15)
A copy of all solicitation documents;

(16)
A balance sheet and other financial statements showing the
applicant's assets, liabilities, income, and other sources of
financial support;

(17)
A description of the nature and extent of any reinsurance program to
be implemented, and a demonstration that errors and omission
insurance and, if appropriate, fidelity insurance, will be in place
upon the applicant's receipt of a certificate of authority;

(18)
Copies of all proposed or in force related-party or intercompany
agreements with an explanation of the financial impact of these
agreements on the applicant. If the applicant intends to enter into a
contract for managerial or administrative services, with either an
affiliated or an unaffiliated person, the applicant shall provide a
copy of the contract and a detailed description of the person to
provide these services. The description shall include that person's
experience in managing or administering health care plans, a copy of
that person's most recent audited financial statement, and a
completed biographical affidavit on a form acceptable to the
superintendent for each of that person's principal officers and board
members and for any additional employee to be directly involved in
providing managerial or administrative services to the health
insuring corporation. If the person to provide managerial or
administrative services is affiliated with the health insuring
corporation, the contract must provide for payment for services based
on actual costs.

(19)
A statement from the applicant's board that the admitted assets of
the applicant have not been and will not be pledged or hypothecated;

(20)
A statement from the applicant's board that the applicant will submit
monthly financial statements during the first year of operations;

(21)
The name and address of the applicant's Ohio statutory agent for
service of process, notice, or demand;

(22)
Copies of all documents the applicant filed with the secretary of
state;

(23)
The location of those books and records of the applicant that must be
maintained, which books and records shall be maintained in Ohio if
the applicant is a domestic corporation, and which may be maintained
either in the applicant's state of domicile or in Ohio if the
applicant is a foreign corporation;

(24)
The applicant's federal identification number, corporate address, and
mailing address;

(25)
An internal and external organizational chart;

(26)
A list of the assets representing the initial net worth of the
applicant;

(27)
If the applicant has a parent company, the parent company's guaranty,
on a form acceptable to the superintendent, that the applicant will
maintain Ohio's minimum net worth. If no parent company exists, a
statement regarding the availability of future funds if needed.

(28)
The names and addresses of the applicant's actuary and external
auditors;

(29)
If the applicant is a foreign corporation, a copy of the most recent
financial statements filed with the insurance regulatory agency in
the applicant's state of domicile;

(30)
If the applicant is a foreign corporation, a statement from the
insurance regulatory agency of the applicant's state of domicile
stating that the regulatory agency has no objection to the applicant
applying for an Ohio license and that the applicant is in good
standing in the applicant's state of domicile;

(31)
Any other information that the superintendent may require
;

(32)
Documentation acceptable to the superintendent of the bond or
securities required by section 1751.271 of the Revised Code
.

(B)(1)
A health insuring corporation, unless otherwise provided for in this
chapter or in section 3901.321 of the Revised Code, shall file a
timely notice with the superintendent describing any change to the
corporation's articles of incorporation or regulations, or any major
modification to its operations as set out in the information required
by division (A) of this section that affects any of the following:

(a)
The solvency of the health insuring corporation;

(b)
The health insuring corporation's continued provision of services
that it has contracted to provide;

(c)
The manner in which the health insuring corporation conducts its
business.

(2)
If the change or modification is to be the result of an action to be
taken by the health insuring corporation, the notice shall be filed
with the superintendent prior to the health insuring corporation
taking the action. The action shall be deemed approved if the
superintendent does not disapprove it within sixty days of filing.

(3)
The filing of a notice pursuant to division (B)(1) or (2) of this
section shall also serve as the submission of a notice when required
for the superintendent's review for purposes of section 3901.341 of
the Revised Code, if the notice contains all of the information that
section 3901.341 of the Revised Code requires for such submissions
and a copy of any written agreement. The filing of such a notice, for
the purpose of satisfying this division and section 3901.341 of the
Revised Code, shall be subject to the sixty-day review period of
division (B)(2) of this section.

(C)(1)
No health insuring corporation shall expand its approved service area
until a copy of the request for expansion, accompanied by
documentation of the network of providers, forms of all proposed or
existing provider contracts relating to the delivery of health care
services, a schedule of proposed contractual periodic prepayments and
premium rates for group contracts accompanied by appropriate
supporting data, enrollment projections, plan of operation, and any
other changes have been filed with the superintendent.

(2)
Within seventy-five days after the superintendent's receipt of a
complete filing under division (C)(1) of this section, the
superintendent shall determine whether the plan for expansion is
lawful, fair, and reasonable.

If
the superintendent has not approved or disapproved all or a portion
of a service area expansion within the seventy-five-day period, the
filing shall be deemed approved.

(3)
Disapproval of all or a portion of the filing shall be effected by
written notice, which shall state the grounds for the order of
disapproval and shall be given in accordance with Chapter 119. of the
Revised Code.

(D)
The agent named under division (A)(21) of this section shall be one
of the following:

(1)
A natural person who is a resident of this state;

(2)
A domestic or foreign corporation, nonprofit corporation, limited
liability company, partnership, limited partnership, limited
liability partnership, limited partnership association, professional
association, business trust, or unincorporated nonprofit association
that has a business address in this state. If the agent is an entity
other than a domestic corporation, the agent shall meet the
requirements of Title XVII of the Revised Code for an entity of the
agent's type to transact business or exercise privileges in this
state.

Sec.
3701.741.
(A)
Each health care provider and medical records company shall provide
copies of medical records in accordance with this section.

(B)
Except as provided in divisions (C) and (E) of this section, a health
care provider or medical records company that receives a request for
a copy of a patient's medical record shall charge not more than the
amounts set forth in this section.

(1)(a)
Except as provided in division (B)(1)(b) of this section, if the
request is made by the patient, the patient's personal
representative, or an individual authorized to access the patient's
medical record through a valid power of attorney, total costs for
copies and all services related to those copies shall be reasonable,
cost-based amounts permitted to be charged to the patient under
federal laws and regulations. Any per page charges shall not exceed
the sum of the per page charges authorized in division (B)(2)(b) and
(c) of this section.

(b)
If the request is made by a person identified in division (B)(1)(a)
of this section and the request is for access to digital records or
electronically transmitted records, the total cost for that access or
for the electronic transmission, and all related services, shall not
exceed fifty dollars.

(2)
If the request is made by anyone other than a person identified in
division (B)(1)(a) of this section, total costs for copies and all
services related to those copies shall not exceed the sum of the
following:

(a)
An initial fee of sixteen dollars and eighty-four cents adjusted in
accordance with section 3701.742 of the Revised Code, which shall
compensate for the records search;

(b)
Except as provided in division (B)(2)(c) of this section, with
respect to data recorded on paper or electronically, the following
amounts adjusted in accordance with section 3701.742 of the Revised
Code:

(i)
One dollar and eleven cents per page for the first ten pages;

(ii)
Fifty-seven cents per page for pages eleven through fifty;

(iii)
Twenty-three cents per page for pages fifty-one and higher.

(c)
With respect to data resulting from an x-ray, magnetic resonance
imaging (MRI), or computed axial tomography (CAT) scan and recorded
on paper or film, one dollar and eighty-seven cents per page;

(d)
The actual cost of any related postage incurred by the health care
provider or medical records company.

(C)(1)
On request, a health care provider or medical records company shall
provide one copy of the patient's medical record and one copy of any
records regarding treatment performed subsequent to the original
request, not including copies of records already provided, without
charge to the following:

(a)
The bureau of workers' compensation, in accordance with Chapters
4121. and 4123. of the Revised Code and the rules adopted under those
chapters;

(b)
The industrial commission, in accordance with Chapters 4121. and
4123. of the Revised Code and the rules adopted under those chapters;

(c)
The department of medicaid or a county department of job and family
services, in accordance with Chapters 5160., 5161., 5162., 5163.,
5164., 5165.,
and

5166.
,
and 5167.

of the Revised Code and the rules adopted under those chapters;

(d)
The attorney general, in accordance with sections 2743.51 to 2743.72
of the Revised Code and any rules that may be adopted under those
sections;

(e)
A patient, patient's personal representative, or authorized person if
the medical record is necessary to support a claim under Title II or
Title XVI of the "Social Security Act," 49 Stat. 620
(1935), 42 U.S.C.A. 401 and 1381, as amended, and the request is
accompanied by documentation that a claim has been filed.

(2)
Nothing in division (C)(1) of this section requires a health care
provider or medical records company to provide a copy without charge
to any person or entity not listed in division (C)(1) of this
section.

(D)
Division (C) of this section shall not be construed to supersede any
rule of the bureau of workers' compensation, the industrial
commission, or the department of medicaid.

(E)
A health care provider or medical records company may enter into a
contract with either of the following for the copying of medical
records at a fee other than as provided in division (B) of this
section:

(1)
A patient, a patient's personal representative, or an authorized
person;

(2)
An insurer authorized under Title XXXIX of the Revised Code to do the
business of sickness and accident insurance in this state or health
insuring corporations holding a certificate of authority under
Chapter 1751. of the Revised Code.

(F)
This section does not apply to medical records the copying of which
is covered by section 173.20 of the Revised Code or by 42 C.F.R.
483.10.

Sec.
3901.81.
As
used in this section and sections 3901.811 to 3901.815 of the Revised
Code:

(A)
"Auditing entity" means any person or government entity
that performs a pharmacy audit, including a payer, a pharmacy benefit
manager, or a third-party administrator licensed under Chapter 3959.
of the Revised Code.

(B)
"Business day" means any day of the week excluding
Saturday, Sunday, and a legal holiday, as defined in section 1.14 of
the Revised Code.

(C)
"Concurrent review" means a claims review within five
business days of submission of claims for payment for the provision
of dangerous drugs for which the payer or the auditing entity does
not impose a penalty or demand to recoup money from the pharmacy in
any amount.

(D)
"Dangerous drug," "pharmacy," "practice of
pharmacy," and "prescription" have the same meanings
as in section 4729.01 of the Revised Code.

(E)
"Payer" means any of the following that pays for or
processes a claim for payment for the provision of dangerous drugs or
pharmacy services:

(1)
A health insuring corporation, as defined in section 1751.01 of the
Revised Code;

(2)
A person authorized to engage in the business of sickness and
accident insurance under Title XXXIX of the Revised Code;

(3)
A person or government entity providing coverage of dangerous drugs
or pharmacy services to individuals on a self-insurance basis;

(4)
A group health plan, as defined in 29 U.S.C. 1167;

(5)
A service benefit plan, as referenced in 42 U.S.C. 1396a(a)(25);

(6)

A
medicaid managed care organization that has entered into a contract
with the department of medicaid pursuant to section 5167.10 of the
Revised Code;

(7)

Any other person or government entity that is, by law, contract, or
agreement, responsible for paying for or processing a claim for
payment for the provision of dangerous drugs or pharmacy services.

(F)
"Pharmacy audit" means a review of one or more pharmacy
records conducted by an auditing entity, one purpose of which is to
identify discrepancies in claims for payment for the provision of
dangerous drugs or pharmacy services. "Pharmacy audit" does
not include concurrent review.

(G)
"Pharmacy benefit manager" means a person that provides
administrative services related to the processing of claims for
payment for the provision of dangerous drugs or pharmacy services,
including performing pharmacy audit compliance, negotiating
pharmaceutical rebate agreements, developing and managing drug
formularies and preferred drug lists, and administering programs for
payers' prior authorization of claims for payment for the provision
of dangerous drugs or pharmacy services.

(H)
"Pharmacy record" means any record stored electronically or
as a hard copy by a pharmacy that relates to the provision of
dangerous drugs or pharmacy services or any other component of
pharmacist care that is included in the practice of pharmacy.

Sec.
3902.70.
As
used in this section and section 3902.71 of the Revised Code:

(A)
"340B covered entity" means an entity described in section
340B(a)(4) of the "Public Health Service Act," 42 U.S.C.
256b(a)(4) and includes any pharmacy under contract with the entity
to dispense drugs on behalf of the entity.

(B)
"Terminal distributor of dangerous drugs" has the same
meaning as in section 4729.01 of the Revised Code.

(C)
"Third-party administrator" has the same meaning as in
section
5167.01

4729.49

of
the Revised Code.

Sec.
3903.14.
(A)
The superintendent of insurance as rehabilitator may appoint one or
more special deputies, who shall have all the powers and
responsibilities of the rehabilitator granted under this section, and
the superintendent may employ such clerks and assistants as
considered necessary. The compensation of the special deputies,
clerks, and assistants and all expenses of taking possession of the
insurer and of conducting the proceedings shall be fixed by the
superintendent, with the approval of the court and shall be paid out
of the funds or assets of the insurer. The persons appointed under
this section shall serve at the pleasure of the superintendent. In
the event that the property of the insurer does not contain
sufficient cash or liquid assets to defray the costs incurred, the
superintendent may advance the costs so incurred out of any
appropriation for the maintenance of the department of insurance. Any
amounts so advanced for expenses of administration shall be repaid to
the superintendent for the use of the department out of the first
available money of the insurer.

(B)
The rehabilitator may take such action as the rehabilitator considers
necessary or appropriate to reform and revitalize the insurer. The
rehabilitator shall have all the powers of the directors, officers,
and managers, whose authority shall be suspended, except as they are
redelegated by the rehabilitator. The rehabilitator shall have full
power to direct and manage, to hire and discharge employees subject
to any contract rights they may have, and to deal with the property
and business of the insurer.

(C)
If it appears to the rehabilitator that there has been criminal or
tortious conduct, or breach of any contractual or fiduciary
obligation detrimental to the insurer by any officer, manager, agent,
director, trustee, broker, employee, or other person, the
rehabilitator may pursue all appropriate legal remedies on behalf of
the insurer.

(D)
If the rehabilitator determines that reorganization, consolidation,
conversion, reinsurance, merger, or other transformation of the
insurer is appropriate, the rehabilitator shall prepare a plan to
effect such changes. Upon application of the rehabilitator for
approval of the plan, and after such notice and hearings as the court
may prescribe, the court may either approve or disapprove the plan
proposed, or may modify it and approve it as modified. Any plan
approved under this section shall be, in the judgment of the court,
fair and equitable to all parties concerned. If the plan is approved,
the rehabilitator shall carry out the plan. In the case of a life
insurer, the plan proposed may include the imposition of liens upon
the policies of the company, if all rights of shareholders are first
relinquished. A plan for a life insurer may also propose imposition
of a moratorium upon loan and cash surrender rights under policies,
for such period and to such an extent as may be necessary.

(E)

In
the case of a medicaid health insuring corporation that has posted a
bond or deposited securities in accordance with section 1751.271 of
the Revised Code, the plan proposed under division (D) of this
section may include the use of the proceeds of the bond or securities
to first pay the claims of contracted providers for covered health
care services provided to medicaid recipients, then next to pay other
claimants with any remaining funds, consistent with the priorities
set forth in sections 3903.421 and 3903.42 of the Revised Code.

(F)

The
rehabilitator shall have the power under sections 3903.26 and 3903.27
of the Revised Code to avoid fraudulent transfers.

(G)
As used in this section:

(1)
"Contracted provider" means a provider with a contract with
a medicaid health insuring corporation to provide covered health care
services to medicaid recipients.

(2)
"Medicaid recipient" means a person enrolled in the
medicaid program.

Sec.
3903.42.
The
priority of distribution of claims from the insurer's estate shall be
in accordance with the order in which each class of claims is set
forth in this section. Every claim in each class shall be paid in
full or adequate funds retained for such payment before the members
of the next class receive any payment. No subclasses shall be
established within any class. The order of distribution of claims
shall be:

(A)
Class 1. The costs and expenses of administration, including but not
limited to the following:

(1)
The actual and necessary costs of preserving or recovering the assets
of the insurer;

(2)
Compensation for all services rendered in the liquidation;

(3)
Any necessary filing fees;

(4)
The fees and mileage payable to witnesses;

(5)
Reasonable attorney's fees;

(6)
The reasonable expenses of a guaranty association or foreign guaranty
association in handling claims.

(B)
Class 2. All claims under policies for losses incurred, including
third party claims,
all
claims of contracted providers against a medicaid health insuring
corporation for covered health care services provided to medicaid
recipients,
all
claims against the insurer for liability for bodily injury or for
injury to or destruction of tangible property that are not under
policies, and all claims of a guaranty association or foreign
guaranty association. All claims under life insurance, annuity
policies, and funding agreements, whether for death proceeds, annuity
proceeds, investment values, principal, or interest, shall be treated
as loss claims. That portion of any loss, indemnification for which
is provided by other benefits or advantages recovered by the
claimant, shall not be included in this class, other than benefits or
advantages recovered or recoverable in discharge of familial
obligations of support or by way of succession at death or as
proceeds of life insurance, or as gratuities. No payment by an
employer to an employee shall be treated as a gratuity. Claims under
nonassessable policies for unearned premium or other premium refunds.

(C)
Class 3. Claims of the federal government.

(D)
Class 4. Debts due to employees for services performed to the extent
that they do not exceed one thousand dollars and represent payment
for services performed within one year before the filing of the
complaint for liquidation. Officers and directors shall not be
entitled to the benefit of this priority. Such priority shall be in
lieu of any other similar priority that may be authorized by law as
to wages or compensation of employees.

(E)
Class 5. Claims of general creditors.

(F)
Class 6. Claims of any state or local government. Claims, including
those of any state or local governmental body for a penalty or
forfeiture, shall be allowed in this class only to the extent of the
pecuniary loss sustained from the act, transaction, or proceeding out
of which the penalty or forfeiture arose, with reasonable and actual
costs occasioned thereby. The remainder of such claims shall be
postponed to the class of claims under division (J) of this section.

(G)
Class 7. Claims filed late or any other claims other than claims
under divisions (H), (I), and (J) of this section.

(H)
Class 8. Surplus or contribution notes, or similar obligations, and
premium refunds on assessable policies. Payments to members of
domestic mutual insurance companies shall be limited in accordance
with law.

(I)
Class 9. Interest at the legal rate compounded annually on all claims
in the classes prescribed in divisions (A) to (H) of this section,
except for claims of the federal government, from the date of the
order for liquidation or the date on which the claim becomes due,
whichever is later, until the date on which the interest or dividend
is declared, according to the terms of a plan proposed by the
liquidator and approved by the court supervising the liquidation. The
liquidator, with the approval of the court, may make reasonable
approximate computations of interest to be paid under this division.

(J)
Class 10. The claims of shareholders or other owners.

If
any provision of this section or the application of any provision of
this section to any person or circumstance is held invalid, the
invalidity does not affect other provisions or applications of this
section, and to this end the provisions are severable.

(K)
As used in sections 3903.42 and 3903.421 of the Revised Code,
"contracted provider" and "medicaid recipient"
have the same meanings as in section 3903.14 of the Revised Code.

Sec.
3959.01.
As
used in this chapter:

(A)
"Administration fees" means any amount charged a covered
person for services rendered. "Administration fees"
includes commissions earned or paid by any person relative to
services performed by an administrator.

(B)
"Administrator" means any person who adjusts or settles
claims on, residents of this state in connection with life, dental,
health, prescription drugs, or disability insurance or self-insurance
programs. "Administrator" includes a pharmacy benefit
manager. "Administrator" does not include any of the
following:

(1)
An insurance agent or solicitor licensed in this state whose
activities are limited exclusively to the sale of insurance and who
does not provide any administrative services;

(2)
Any person who administers or operates the workers' compensation
program of a self-insuring employer under Chapter 4123. of the
Revised Code;

(3)
Any person who administers pension plans for the benefit of the
person's own members or employees or administers pension plans for
the benefit of the members or employees of any other person;

(4)
Any person that administers an insured plan or a self-insured plan
that provides life, dental, health, or disability benefits
exclusively for the person's own members or employees;

(5)
Any health insuring corporation holding a certificate of authority
under Chapter 1751. of the Revised Code or an insurance company that
is authorized to write life or sickness and accident insurance in
this state.

(C)
"Aggregate excess insurance" means that type of coverage
whereby the insurer agrees to reimburse the insured employer or trust
for all benefits or claims paid during an agreement period on behalf
of all covered persons under the plan or trust which exceed a stated
deductible amount and subject to a stated maximum.

(D)
"Contracted pharmacy" or "pharmacy" means a
pharmacy located in this state participating in either the network of
a pharmacy benefit manager or in a health care or pharmacy benefit
plan through a direct contract or through a contract with a pharmacy
services administration organization, group purchasing organization,
or another contracting agent.

(E)
"Contributions" means any amount collected from a covered
person to fund the self-insured portion of any plan in accordance
with the plan's provisions, summary plan descriptions, and contracts
of insurance.

(F)
"Drug product reimbursement" means the amount paid by a
pharmacy benefit manager to a contracted pharmacy for the cost of the
drug dispensed to a patient and does not include a dispensing or
professional fee.

(G)
"Fiduciary" has the meaning set forth in section
1002(21)(A) of the "Employee Retirement Income Security Act of
1974," 88 Stat. 829, 29 U.S.C. 1001, as amended.

(H)
"Fiscal year" means the twelve-month accounting period
commencing on the date the plan is established and ending twelve
months following that date, and each corresponding twelve-month
accounting period thereafter as provided for in the summary plan
description.

(I)
"Insurer" means an entity authorized to do the business of
insurance in this state or, for the purposes of this section, a
health insuring corporation authorized to issue health care plans in
this state.

(J)
"Managed care organization" means an entity that provides
medical management and cost containment services

and includes a medicaid managed care organization, as defined in
section 5167.01 of the Revised Code
.

(K)
"Maximum allowable cost" means a maximum drug product
reimbursement for an individual drug or for a group of
therapeutically and pharmaceutically equivalent multiple source drugs
that are listed in the United States food and drug administration's
approved drug products with therapeutic equivalence evaluations,
commonly referred to as the orange book.

(L)
"Maximum allowable cost list" means a list of the drugs for
which a pharmacy benefit manager imposes a maximum allowable cost.

(M)
"Multiple employer welfare arrangement" has the same
meaning as in section 1739.01 of the Revised Code.

(N)
"Pharmacy benefit manager" means an entity that contracts
with pharmacies on behalf of an employer, a multiple employer welfare
arrangement, public employee benefit plan, state agency, insurer,
managed care organization, or other third-party payer to provide
pharmacy health benefit services or administration.
"Pharmacy
benefit manager" includes the state pharmacy benefit manager
selected under section 5167.24 of the Revised Code.

(O)
"Plan" means any arrangement in written form for the
payment of life, dental, health, or disability benefits to covered
persons defined by the summary plan description and includes a drug
benefit plan administered by a pharmacy benefit manager.

(P)
"Plan sponsor" means the person who establishes the plan.

(Q)
"Self-insurance program" means a program whereby an
employer provides a plan of benefits for its employees without
involving an intermediate insurance carrier to assume risk or pay
claims. "Self-insurance program" includes but is not
limited to employer programs that pay claims up to a prearranged
limit beyond which they purchase insurance coverage to protect
against unpredictable or catastrophic losses.

(R)
"Specific excess insurance" means that type of coverage
whereby the insurer agrees to reimburse the insured employer or trust
for all benefits or claims paid during an agreement period on behalf
of a covered person in excess of a stated deductible amount and
subject to a stated maximum.

(S)
"Summary plan description" means the written document
adopted by the plan sponsor which outlines the plan of benefits,
conditions, limitations, exclusions, and other pertinent details
relative to the benefits provided to covered persons thereunder.

(T)
"Third-party payer" has the same meaning as in section
3901.38 of the Revised Code.

Sec.
3963.06.
(A)
If a provider, upon the oral or written request of a contracting
entity to submit a credentialing form, submits a credentialing form
that is not complete, the contracting entity that receives the form
shall notify the provider of the deficiency electronically, by
facsimile, or by certified mail, return receipt requested, not later
than twenty-one days after the contracting entity receives the form.

(B)
If a contracting entity receives any information that is inconsistent
with the information given by the provider in the credentialing form,
the contracting entity may request the provider to submit a written
clarification of the inconsistency. The contracting entity shall send
the request described in this division electronically, by facsimile,
or by certified mail, return receipt requested.

(C)(1)

Except
as otherwise provided in division (C)(2) of this section, the
The

credentialing
process under this section starts when a provider initially submits a
credentialing form upon the oral or written request of a contracting
entity, and the provider shall submit the credentialing form to the
contracting entity electronically, by facsimile, or by certified
mail, return receipt requested. Subject to division
(C)(3)
(C)(2)

of this section, a contracting entity shall complete the
credentialing process not later than ninety days after the
contracting entity receives that credentialing form from the
provider. The contracting entity shall allow the provider to submit a
credentialing application prior to the provider's employment. A
contracting entity that does not complete the credentialing process
within the ninety-day period specified in this division is liable for
either a civil penalty payable to the provider in the amount of five
hundred dollars per day, including weekend days, starting at the
expiration of that ninety-day period until the provider's
credentialing application is granted or denied or retroactive
reimbursement to the provider according to the terms of the contract
for any basic health care services, specialty health care services,
or supplemental health care services the provider provided to
enrollees starting at the expiration of that ninety-day period until
the provider's credentialing application is granted or denied. When
the credentialing process of the contracting entity exceeds the
ninety-day period, the contracting entity shall select the liability
to which the contracting entity is subject and shall inform the
provider of the contracting entity's selection.

(2)

The
credentialing process for a medicaid managed care plan starts when
the provider submits a credentialing form and the provider's national
provider number issued by the centers for medicare and medicaid
services.

(3)

The
requirement that the credentialing process be completed within the
ninety-day period specified in division (C)(1) of this section does
not apply to a contracting entity if a provider that submits a
credentialing form to the contracting entity under that division is a
hospital.

(D)
Any communication between the provider and the contracting entity
shall be electronically, by facsimile, or by certified mail, return
receipt requested.

(E)
If the state medical board or its agent has primary source verified
the medical education, graduate medical education, and examination
history of the physician, or the status of the physician with the
educational commission for foreign medical graduates, if applicable,
the contracting entity may accept the documentation of primary source
verification from the state medical board's web site or from its
agent and is not required to perform primary source verification of
the medical education, graduate medical education, and examination
history of the physician or the status of the physician with the
educational commission for foreign medical graduates, if applicable,
as a condition for initially credentialing or recredentialing the
physician.

Sec.
4121.50.
Not
later than July 1, 2012, the administrator of workers' compensation
shall adopt rules in accordance with Chapter 119. of the Revised Code
to implement a coordinated services program for claimants under this
chapter or Chapter 4123., 4127., or 4131. of the Revised Code who are
found to have obtained prescription drugs that were reimbursed
pursuant to an order of the administrator or of the industrial
commission or by a self-insuring employer but were obtained at a
frequency or in an amount that is not medically necessary. The
program shall be implemented in a manner that is substantially
similar to the coordinated services programs established for the
medicaid program under
sections

section

5164.758

and 5167.13

of the Revised Code.

Sec.
4729.20.
As
used in this section, "medication synchronization" means a
pharmacy service that synchronizes the filling or refilling of
prescriptions in a manner that allows the dispensed drugs to be
obtained on the same date each month.

A
pharmacist may dispense a drug in a manner that varies from the
prescription for the drug by dispensing a quantity or amount of the
drug that is less than a thirty-day supply, if the pharmacist's
action is taken solely for the purpose of medication synchronization
pursuant to section 1751.68, 3923.602,
or

5164.7511
,
or 5167.12

of the Revised Code.

Sec.
4729.49.
(A)
As used in this section:

(1)
"340B covered entity" has the same meaning as in section
3902.70 of the Revised Code.

(2)

"Medicaid
managed care organization," and "third-party
"Third-party

administrator"

have
the same meanings as in section 5167.01 of the Revised Code
means
any person who adjusts or settles claims on behalf of an insuring
entity in connection with life, dental, health, prescription drugs,
or disability insurance or self-insurance programs and includes a
pharmacy benefit manager
.

(B)
A contract between a terminal distributor of dangerous drugs and a
340B covered entity shall require the terminal distributor to comply
with division (C) of this section.

(C)
When paying a 340B covered entity for a dangerous drug dispensed to a
patient, a terminal distributor shall pay to the 340B covered entity
the full reimbursement amount the terminal distributor receives from
the patient and the patient's health insurer, including a third-party
administrator

or medicaid managed care organization
,
except that the terminal distributor may deduct from the full
reimbursement amount a fee agreed on in writing by the terminal
distributor and the 340B covered entity.

Sec.
4729.80.
(A)
If the state board of pharmacy establishes and maintains a drug
database pursuant to section 4729.75 of the Revised Code, the board
is authorized or required to provide information from the database
only as follows:

(1)
On receipt of a request from a designated representative of a
government entity responsible for the licensure, regulation, or
discipline of health care professionals with authority to prescribe,
administer, or dispense drugs, the board may provide to the
representative information from the database relating to the
professional who is the subject of an active investigation being
conducted by the government entity or relating to a professional who
is acting as an expert witness for the government entity in such an
investigation.

(2)
On receipt of a request from a federal officer, or a state or local
officer of this or any other state, whose duties include enforcing
laws relating to drugs, the board shall provide to the officer
information from the database relating to the person who is the
subject of an active investigation of a drug abuse offense, as
defined in section 2925.01 of the Revised Code, being conducted by
the officer's employing government entity.

(3)
Pursuant to a subpoena issued by a grand jury, the board shall
provide to the grand jury information from the database relating to
the person who is the subject of an investigation being conducted by
the grand jury.

(4)
Pursuant to a subpoena, search warrant, or court order in connection
with the investigation or prosecution of a possible or alleged
criminal offense, the board shall provide information from the
database as necessary to comply with the subpoena, search warrant, or
court order.

(5)
On receipt of a request from a prescriber or the prescriber's
delegate approved by the board, the board shall provide to the
prescriber a report of information from the database relating to a
patient who is either a current patient of the prescriber or a
potential patient of the prescriber based on a referral of the
patient to the prescriber, if all of the following conditions are
met:

(a)
The prescriber certifies in a form specified by the board that it is
for the purpose of providing medical treatment to the patient who is
the subject of the request;

(b)
The prescriber has not been denied access to the database by the
board.

(6)
On receipt of a request from a pharmacist or the pharmacist's
delegate approved by the board, the board shall provide to the
pharmacist information from the database relating to a current
patient of the pharmacist, if the pharmacist certifies in a form
specified by the board that it is for the purpose of the pharmacist's
practice of pharmacy involving the patient who is the subject of the
request and the pharmacist has not been denied access to the database
by the board.

(7)
On receipt of a request from an individual seeking the individual's
own database information in accordance with the procedure established
in rules adopted under section 4729.84 of the Revised Code, the board
may provide to the individual the individual's own prescription
history.

(8)

On
receipt of a request from a medical director or a pharmacy director
of a managed care organization that has entered into a contract with
the department of medicaid under section 5167.10 of the Revised Code
and a data security agreement with the board required by section
5167.14 of the Revised Code, the board shall provide to the medical
director or the pharmacy director information from the database
relating to a medicaid recipient enrolled in the managed care
organization, including information in the database related to
prescriptions for the recipient that were not covered or reimbursed
under a program administered by the department of medicaid.

(9)

On
receipt of a request from the medicaid director, the board shall
provide to the director information from the database relating to a
recipient of a program administered by the department of medicaid,
including information in the database related to prescriptions for
the recipient that were not covered or paid by a program administered
by the department.

(10)
(9)

On receipt of a request from a medical director of a managed care
organization that has entered into a contract with the administrator
of workers' compensation under division (B)(4) of section 4121.44 of
the Revised Code and a data security agreement with the board
required by section 4121.447 of the Revised Code, the board shall
provide to the medical director information from the database
relating to a claimant under Chapter 4121., 4123., 4127., or 4131. of
the Revised Code assigned to the managed care organization, including
information in the database related to prescriptions for the claimant
that were not covered or reimbursed under Chapter 4121., 4123.,
4127., or 4131. of the Revised Code, if the administrator of workers'
compensation confirms, upon request from the board, that the claimant
is assigned to the managed care organization.

(11)
(10)

On receipt of a request from the administrator of workers'
compensation, the board shall provide to the administrator
information from the database relating to a claimant under Chapter
4121., 4123., 4127., or 4131. of the Revised Code, including
information in the database related to prescriptions for the claimant
that were not covered or reimbursed under Chapter 4121., 4123.,
4127., or 4131. of the Revised Code.

(12)
(11)

On receipt of a request from a prescriber or the prescriber's
delegate approved by the board, the board shall provide to the
prescriber information from the database relating to a patient's
mother, if the prescriber certifies in a form specified by the board
that it is for the purpose of providing medical treatment to a
newborn or infant patient diagnosed as opioid dependent and the
prescriber has not been denied access to the database by the board.

(13)
(12)

On receipt of a request from the director of health, the board shall
provide to the director information from the database relating to the
duties of the director or the department of health in implementing
the Ohio violent death reporting system established under section
3701.93 of the Revised Code.

(14)
(13)

On receipt of a request from a requestor described in division
(A)(1), (2), (5), or (6) of this section who is from or participating
with another state's prescription monitoring program, the board may
provide to the requestor information from the database, but only if
there is a written agreement under which the information is to be
used and disseminated according to the laws of this state.

(15)
(14)

On receipt of a request from a delegate of a retail dispensary
licensed under Chapter 3796. of the Revised Code who is approved by
the board to serve as the dispensary's delegate, the board shall
provide to the delegate a report of information from the database
pertaining only to a patient's use of medical marijuana, if both of
the following conditions are met:

(a)
The delegate certifies in a form specified by the board that it is
for the purpose of dispensing medical marijuana for use in accordance
with Chapter 3796. of the Revised Code.

(b)
The retail dispensary or delegate has not been denied access to the
database by the board.

(16)
(15)

On receipt of a request from a judge of a program certified by the
Ohio supreme court as a specialized docket program for drugs, the
board shall provide to the judge, or an employee of the program who
is designated by the judge to receive the information, information
from the database that relates specifically to a current or
prospective program participant.

(17)
(16)

On receipt of a request from a coroner, deputy coroner, or coroner's
delegate approved by the board, the board shall provide to the
requestor information from the database relating to a deceased person
about whom the coroner is conducting or has conducted an autopsy or
investigation.

(18)
(17)

On receipt of a request from a prescriber, the board may provide to
the prescriber a summary of the prescriber's prescribing record if
such a record is created by the board. Information in the summary is
subject to the confidentiality requirements of this chapter.

(19)
(18)

On receipt of a request from a pharmacy's responsible person
designated under section 4729.54 of the Revised Code, the board may
provide to the responsible person a summary of the pharmacy's
dispensing record if such a record is created by the board.
Information in the summary is subject to the confidentiality
requirements of this chapter.

(20)
(19)

The board may provide information from the database without request
to a prescriber or pharmacist who is authorized to use the database
pursuant to this chapter.

(21)(a)
(20)(a)

On receipt of a request from a prescriber or pharmacist, or the
prescriber's or pharmacist's delegate, who is a designated
representative of a peer review committee, the board shall provide to
the committee information from the database relating to a prescriber
who is subject to the committee's evaluation, supervision, or
discipline if the information is to be used for one of those
purposes. The board shall provide only information that it
determines, in accordance with rules adopted under section 4729.84 of
the Revised Code, is appropriate to be provided to the committee.

(b)
As used in division
(A)(21)(a)
(A)(20)(a)

of this section, "peer review committee" has the same
meaning as in section 2305.25 of the Revised Code, except that it
includes only a peer review committee of a hospital or a peer review
committee of a nonprofit health care corporation that is a member of
the hospital or of which the hospital is a member.

(22)
(21)

On receipt of a request from a requestor described in division (A)(5)
or (6) of this section who is from or participating with a
prescription monitoring program that is operated by a federal agency
and approved by the board, the board may provide to the requestor
information from the database, but only if there is a written
agreement under which the information is to be used and disseminated
according to the laws of this state.

(23)
(22)

Any personal health information submitted to the board pursuant to
section 4729.772 of the Revised Code may be provided by the board
only as authorized by the submitter of the information and in
accordance with rules adopted under section 4729.84 of the Revised
Code.

(24)
(23)

On receipt of a request from a person described in division (A)(5),
(6), or
(17)
(16)

of this section who is participating in a drug overdose fatality
review committee described in section 307.631 of the Revised Code,
the board may provide to the requestor information from the database,
but only if there is a written agreement under which the information
is to be used and disseminated according to the laws of this state.

(25)
(24)

On receipt of a request from a person described in division (A)(5),
(6), or
(17)
(16)

of this section who is participating in a suicide fatality review
committee described in section 307.641 of the Revised Code, the board
may provide to the requestor information from the database, but only
if there is a written agreement under which the information is to be
used and disseminated according to the laws of this state.

(26)
(25)

On receipt of a request from a designated representative of the
division of cannabis control in the department of commerce, the board
shall provide to the representative information from the database
relating to an individual who, or entity that, is the subject of an
active investigation being conducted by the division.

(B)
The state board of pharmacy shall maintain a record of each
individual or entity that requests information from the database
pursuant to this section. In accordance with rules adopted under
section 4729.84 of the Revised Code, the board may use the records to
document and report statistics and law enforcement outcomes.

The
board may provide records of an individual's requests for database
information only to the following:

(1)
A designated representative of a government entity that is
responsible for the licensure, regulation, or discipline of health
care professionals with authority to prescribe, administer, or
dispense drugs who is involved in an active criminal or disciplinary
investigation being conducted by the government entity of the
individual who submitted the requests for database information;

(2)
A federal officer, or a state or local officer of this or any other
state, whose duties include enforcing laws relating to drugs and who
is involved in an active investigation being conducted by the
officer's employing government entity of the individual who submitted
the requests for database information;

(3)
A designated representative of the department of medicaid regarding a
prescriber who is treating or has treated a recipient of a program
administered by the department and who submitted the requests for
database information.

(C)
Information contained in the database and any information obtained
from it is confidential and is not a public record. Information
contained in the records of requests for information from the
database is confidential and is not a public record. Information
contained in the database that does not identify a person, including
any licensee or registrant of the board or other entity, may be
released in summary, statistical, or aggregate form.

(D)
A pharmacist or prescriber shall not be held liable in damages to any
person in any civil action for injury, death, or loss to person or
property on the basis that the pharmacist or prescriber did or did
not seek or obtain information from the database.

Sec.
4729.84.
For
purposes of establishing and maintaining a drug database pursuant to
section 4729.75 of the Revised Code, the state board of pharmacy
shall adopt rules in accordance with Chapter 119. of the Revised Code
to carry out and enforce sections 4729.75 to 4729.83 of the Revised
Code. The rules shall specify all of the following:

(A)
A means of identifying each patient, each terminal distributor of
dangerous drugs, each purchase at wholesale of dangerous drugs, and
each retail dispensary licensed under Chapter 3796. of the Revised
Code about which information is entered into the drug database;

(B)
Requirements for the transmission of information from terminal
distributors of dangerous drugs, manufacturers of dangerous drugs,
outsourcing facilities, repackagers of dangerous drugs, wholesale
distributors of dangerous drugs, prescribers, and retail
dispensaries;

(C)
An electronic format for the submission of information from persons
identified in division (B) of this section;

(D)
A procedure whereby a person unable to submit information
electronically may obtain a waiver to submit information in another
format;

(E)
A procedure whereby the board may grant a request from a law
enforcement agency or a government entity responsible for the
licensure, regulation, or discipline of licensed health professionals
authorized to prescribe drugs that information that has been stored
for three years be retained when the information pertains to an open
investigation being conducted by the agency or entity;

(F)
A procedure whereby a person identified in division (B) of this
section may apply for an extension to the time by which information
must be transmitted to the board;

(G)
A procedure whereby a person or government entity to which the board
is authorized to provide information may submit a request to the
board for the information and the board may verify the identity of
the requestor;

(H)
Standards for determining what information is appropriate to be
provided under division
(A)(21)
(A)(20)

of section 4729.80 of the Revised Code;

(I)
A procedure whereby the board can use the database request records
required by division (B) of section 4729.80 of the Revised Code to
document and report statistics and law enforcement outcomes;

(J)
A procedure whereby an individual may request the individual's own
database information and the board may verify the identity of the
requestor;

(K)
A reasonable fee that the board may charge under section 4729.83 of
the Revised Code for providing an individual with the individual's
own database information pursuant to section 4729.80 of the Revised
Code;

(L)
The other specific dangerous drugs that, in addition to controlled
substances, must be included in the database;

(M)
The types of pharmacies licensed as terminal distributors of
dangerous drugs that are required to submit prescription information
to the board pursuant to section 4729.77 of the Revised Code;

(N)
Additional data fields, recognized by the American society for
automation in pharmacy, that licensed terminal distributors of
dangerous drugs must submit to the board pursuant to section 4729.77
of the Revised Code;

(O)
The information regarding medical marijuana dispensed to a patient
that a retail dispensary is required to submit to the board pursuant
to section 4729.771 of the Revised Code;

(P)
Requirements for the transmission of information pursuant to section
4729.772 of the Revised Code and requirements for the release of such
information by the board.

Sec.
4729.86.
If
the state board of pharmacy establishes and maintains a drug database
pursuant to section 4729.75 of the Revised Code, all of the following
apply:

(A)(1)
No person identified in divisions (A)(1) to
(13)
(12)
,

(15)
(14)

to
(26)
(25)
,
or (B) of section 4729.80 of the Revised Code shall disseminate any
written or electronic information the person receives from the drug
database or otherwise provide another person access to the
information that the person receives from the database, except as
follows:

(a)
When necessary in the investigation or prosecution of a possible or
alleged criminal offense;

(b)
When a person provides the information to the prescriber, pharmacist,
or retail dispensary licensed under Chapter 3796. of the Revised Code
for whom the person is approved by the board to serve as a delegate
of the prescriber, pharmacist, or retail dispensary for purposes of
requesting and receiving information from the drug database under
division (A)(5), (6), or
(15)
(14)

of section 4729.80 of the Revised Code;

(c)
When a prescriber, pharmacist, or retail dispensary licensed under
Chapter 3796. of the Revised Code provides the information to a
person who is approved by the board to serve as such a delegate of
the prescriber, pharmacist, or retail dispensary;

(d)
When a prescriber or pharmacist includes the information in a medical
record, as defined in section 3701.74 of the Revised Code.

(2)
No person shall provide false information to the state board of
pharmacy with the intent to obtain or alter information contained in
the drug database.

(3)
No person shall obtain drug database information by any means except
as provided under section 4729.80 or 4729.81 of the Revised Code.

(B)
A person shall not use information obtained pursuant to division (A)
of section 4729.80 of the Revised Code as evidence in any civil or
administrative proceeding.

(C)(1)
Except as provided in division (C)(2) of this section, after
providing notice and affording an opportunity for a hearing in
accordance with Chapter 119. of the Revised Code, the board may
restrict a person from obtaining further information from the drug
database if any of the following is the case:

(a)
The person violates division (A)(1), (2), or (3) of this section;

(b)
The person is a requestor identified in division (A)
(14)
(13)

or
(22)
(21)

of section 4729.80 of the Revised Code and the board determines that
the person's actions in another state would have constituted a
violation of division (A)(1), (2), or (3) of this section;

(c)
The person fails to comply with division (B) of this section,
regardless of the jurisdiction in which the failure to comply
occurred;

(d)
The person creates, by clear and convincing evidence, a threat to the
security of information contained in the database.

(2)
If the board determines that allegations regarding a person's actions
warrant restricting the person from obtaining further information
from the drug database without a prior hearing, the board may
summarily impose the restriction. A telephone conference call may be
used for reviewing the allegations and taking a vote on the summary
restriction. The summary restriction shall remain in effect, unless
removed by the board, until the board's final adjudication order
becomes effective.

(3)
The board shall determine the extent to which the person is
restricted from obtaining further information from the database.

Sec.
5160.01.
As
used in this chapter:

(A)
"Dual eligible individual" has the same meaning as in the
"Social Security Act," section 1915(h)(2)(B), 42 U.S.C.
1396n(h)(2)(B). A dual eligible individual is a medicare-medicaid
enrollee (MME).

(B)
"Exchange" has the same meaning as in 45 C.F.R. 155.20.

(C)
"Federal financial participation" means the federal
government's share of expenditures made by an entity in implementing
a medical assistance program.

(D)
"Medical assistance program" means all of the following:

(1)
The medicaid program;

(2)
The children's health insurance program;

(3)
The refugee medical assistance program;

(4)
Any other program that provides medical assistance and state statutes
authorize the department of medicaid to administer.

(E)
"Medical assistance recipient" means a recipient of a
medical assistance program. To the extent appropriate in the context,
"medical assistance recipient" includes an individual
applying for a medical assistance program, a former medical
assistance recipient, or both.

(F)

"Medicaid
managed care organization" has the same meaning as in section
5167.01 of the Revised Code.

(G)

"Refugee
medical assistance program" means the program that the
department of medicaid administers pursuant to section 5160.50 of the
Revised Code.

Sec.
5160.34.
(A)
As used in this section:

(1)
"Chronic condition" means a medical condition that has
persisted after reasonable efforts have been made to relieve or cure
its cause and has continued, either continuously or episodically, for
longer than six continuous months.

(2)
"Clinical peer" means a health care provider in the same,
or in a similar, specialty that typically manages the medical
condition, procedure, or treatment under review.

(3)
"Emergency services" has the same meaning as in section
1753.28 of the Revised Code.

(4)
"Prior authorization requirement" means any practice
implemented by a medical assistance program in which coverage of a
health care service, device, or drug is dependent upon a medical
assistance recipient or a health care provider, receiving approval
from the department of medicaid or its designee
,
including a medicaid managed care organization,

prior to the service, device, or drug being performed, received, or
prescribed, as applicable. "Prior authorization" includes
prospective or utilization review procedures conducted prior to
providing a health care service, device, or drug.

(5)
"Urgent care services" means a medical care or other
service for a condition where application of the timeframe for making
routine or non-life threatening care determinations is either of the
following:

(a)
Could seriously jeopardize the life, health, or safety of the
recipient or others due to the recipient's psychological state;

(b)
In the opinion of a practitioner with knowledge of the recipient's
medical or behavioral condition, would subject the recipient to
adverse health consequences without the care or treatment that is the
subject of the request.

(6)
"Utilization review" and "utilization review
organization" have the same meanings as in section 1751.77 of
the Revised Code.

(B)
If a medical assistance program has a prior authorization
requirement, the department of medicaid or its designee
,
including a medicaid managed care organization,

shall do all of the following:

(1)
On or before January 1, 2018, permit a health care provider to access
the prior authorization form through the applicable electronic
software system.

(2)(a)
On or before January 1, 2018, permit the department or its designee
to accept and respond to prior prescription benefit authorization
requests through a secure electronic transmission.

(b)
On or before January 1, 2018, the department or its designee shall
accept and respond to prior prescription benefit authorization
requests through a secure electronic transmission using NCPDP SCRIPT
standard ePA transactions, and for prior medical benefit
authorization requests through a secure electronic transmission using
standards established by the council for affordable quality health
care on operating rules for information exchange or its successor.

(c)
For purposes of division (B)(2) of this section, neither of the
following shall be considered a secure electronic transmission:

(i)
A facsimile;

(ii)
A proprietary payer portal for prescription drug requests that does
not use NCPDP SCRIPT standard.

(3)
On or before January 1, 2018, a health care provider and the
department of medicaid or its designee may enter into a contractual
arrangement under which the department or its designee agrees to
process prior authorization requests that are not submitted
electronically because of the financial hardship that electronic
submission of prior authorization requests would create for the
provider or if internet connectivity is limited or unavailable where
the provider is located.

(4)(a)
On or before January 1, 2018, if the health care provider submits the
request for prior authorization electronically as described in
divisions (B)(1) and (2) of this section, respond to all prior
authorization requests within forty-eight hours for urgent care
services, or ten calendar days for any prior authorization request
that is not for an urgent care service, of the time the request is
received by the department or its designee. Division (B)(4) of this
section does not apply to emergency services.

(b)
The response required under division (B)(4)(a) of this section shall
indicate whether the request is approved or denied. If the prior
authorization is denied, the department or its designee shall provide
the specific reason for the denial.

(c)
If the prior authorization request is incomplete, the department or
its designee shall indicate the specific additional information that
is required to process the request.

(5)(a)
On or before January 1, 2018, if a health care provider submits a
prior authorization request as described in divisions (B)(1) and (2)
of this section, the department or its designee shall provide an
electronic receipt to the health care provider acknowledging that the
prior authorization request was received.

(b)
On or before January 1, 2018, if the department or its designee
requests additional information that is required to process a prior
authorization request as described in division (B)(4)(c) of this
section, the health care provider shall provide an electronic receipt
to the department or its designee acknowledging that the request for
additional information was received.

(6)(a)
On or before January 1, 2017, honor a prior authorization approval
for an approved drug for the lesser of the following from the date of
approval:

(i)
Twelve months;

(ii)
The last day of the medical assistance recipient's eligibility for
the medical assistance program.

(b)
The duration of all other prior authorization approvals shall be
dictated by the medical assistance program.

(c)
The department or its designee, in relation to prior approval under
division (B)(6)(a) of this section, may require a health care
provider to submit information to the department or its designee
indicating that the patient's chronic condition has not changed.

(i)
The request for information by the department or its designee and the
response by the health care provider shall be in an electronic
format, which may be by electronic mail or other electronic
communication.

(ii)
The frequency of the submission of requested information shall be
consistent with medical or scientific evidence as defined in section
3922.01 of the Revised Code, but shall not be required more
frequently than quarterly.

(iii)
If the health care provider does not respond within five calendar
days from the date the request was received, the insurer or plan may
terminate the twelve-month approval.

(d)
A twelve-month approval provided under division (B)(6)(a) of this
section is no longer valid and automatically terminates if there are
changes to federal or state laws or federal regulatory guidance or
compliance information prescribing that the drug in question is no
longer approved or safe for the intended purpose.

(e)
A twelve-month approval provided under division (B)(6)(a) of this
section does not apply to and is not required for any of the
following:

(i)
Medications that are prescribed for a non-maintenance condition;

(ii)
Medications that have a typical treatment of less than one year;

(iii)
Medications that require an initial trial period to determine
effectiveness and tolerability, beyond which a one-year, or greater,
prior authorization period will be given;

(iv)
Medications where there is medical or scientific evidence as defined
in section 3922.01 of the Revised Code that do not support a
twelve-month prior approval;

(v)
Medications that are a schedule I or II controlled substance or any
opioid analgesic or benzodiazepine, as defined in section 3719.01 of
the Revised Code;

(vi)
Medications that are not prescribed by an in-network provider as part
of a care management program.

(7)
On or before January 1, 2017, the department or its designee may, but
is not required to, provide the twelve-month approval prescribed in
division (B)(6)(a) of this section for a prescription drug that meets
either of the following:

(a)
The drug is prescribed or administered to treat a rare medical
condition and pursuant to medical or scientific evidence as defined
in section 3922.01 of the Revised Code.

(b)
Medications that are controlled substances not included in division
(B)(6)(e)(v) of this section.

For
purposes of division (B)(7) of this section, "rare medical
condition" means any disease or condition that affects fewer
than two-hundred thousand individuals in the United States.

(8)
Nothing in division (B)(6) or (7) of this section prohibits the
substitution, in accordance with section 4729.38 of the Revised Code,
of any drug that has received a twelve-month approval under division
(B)(6)(a) of this section when there is a release of either of the
following:

(a)
A United States food and drug administration approved comparable
brand product or a generic counterpart of a brand product that is
listed as therapeutically equivalent in the United States food and
drug administration's publication titled approved drug products with
therapeutic equivalence evaluations;

(b)
An interchangeable biological product, as defined in section 3715.01
of the Revised Code.

(9)(a)
On or after January 1, 2017, upon written request, the department or
its designee shall permit a retrospective review for a claim that is
submitted for a service where prior authorization was required, but
not obtained if the service in question meets all of the following:

(i)
The service is directly related to another service for which prior
approval has already been obtained and that has already been
performed.

(ii)
The new service was not known to be needed at the time the original
prior authorized service was performed.

(iii)
The need for the new service was revealed at the time the original
authorized service was performed.

(b)
Once the written request and all necessary information is received,
the department or its designee shall review the claim for coverage
and medical necessity. The department or its designee shall not deny
a claim for such a new service based solely on the fact that a prior
authorization approval was not received for the new service in
question.

(10)(a)
On or before January 1, 2017, disclose to all participating health
care providers any new prior authorization requirement at least
thirty days prior to the effective date of the new requirement.

(b)
The notice may be sent via electronic mail or standard mail and shall
be conspicuously entitled "Notice of Changes to Prior
Authorization Requirements." The notice is not required to
contain a complete listing of all changes made to the prior
authorization requirements, but shall include specific information on
where the health care provider may locate the information on the
department's or its designee's web site or, if applicable, the
department's or its designee's portal.

(c)
All participating health care providers shall promptly notify the
department or its designee of any changes to the health care
provider's electronic mail or standard mail address.

(11)(a)
On or before January 1, 2017, make available to all participating
health care providers on its web site or provider portal a listing of
its prior authorization requirements, including specific information
or documentation that a provider must submit in order for the prior
authorization request to be considered complete.

(b)
Make available on its web site information about the medical
assistance programs offered in this state that clearly identifies
specific services, drugs, or devices to which a prior authorization
requirement exists.

(12)
On or before January 1, 2018, establish a streamlined appeal process
relating to adverse prior authorization determinations that shall
include all of the following:

(a)
For urgent care services, the appeal shall be considered within
forty-eight hours after the department or its designee receives the
appeal.

(b)
For all other matters, the appeal shall be considered within ten
calendar days after the department or its designee receives the
appeal.

(c)
The appeal shall be between the health care provider requesting the
service in question and a clinical peer appointed by or contracted by
the department or the department's designee.

(d)
If the appeal does not resolve the disagreement, the appeal
procedures shall permit the recipient to further appeal in accordance
with section 5160.31 of the Revised Code.

(C)
Beginning January 1, 2017, except in cases of fraudulent or
materially incorrect information, the department or its designee
shall not retroactively deny a prior authorization for a health care
service, drug, or device when all of the following are met:

(1)
The health care provider submits a prior authorization request to the
department or its designee for a health care service, drug, or
device.

(2)
The department or its designee approves the prior authorization
request after determining that all of the following are true:

(a)
The recipient is eligible for the health care service, drug, or
device under the medical assistance program.

(b)
The health care service, drug, or device is covered by the medical
assistance program.

(c)
The health care service, drug, or device meets the department's
standards for medical necessity and prior authorization.

(3)
The health care provider renders the health care service, drug, or
device pursuant to the approved prior authorization request and all
of the terms and conditions of the health care provider's contract
with the department or the department's designee.

(4)
On the date the health care provider renders the prior approved
health care service, drug, or device, all of the following are true:

(a)
The recipient is eligible for the medical assistance program.

(b)
The recipient's condition or circumstances related to the recipient's
care has not changed.

(c)
The health care provider submits an accurate claim that matches the
information submitted by the health care provider in the approved
prior authorization request.

(5)
If the health care provider submits a claim that includes an
unintentional error and the error results in a claim that does not
match the information originally submitted by the health care
provider in the approved prior authorization request, upon receiving
a denial of services from the department or its designee, the health
care provider may resubmit the claim pursuant to division (C) of this
section with the information that matches the information included in
the approved prior authorization.

(D)
Any provision of a contractual arrangement entered into between the
department or its designee and a health care provider or recipient
that is contrary to divisions (A) to (C) of this section is
unenforceable.

(E)
The director of medicaid may adopt rules in accordance with Chapter
119. of the Revised Code as necessary to implement the provisions of
this section.

Sec.
5160.37.
(A)
A medical assistance recipient's enrollment in a medical assistance
program gives an automatic right of recovery to the department of
medicaid and a county department of job and family services against
the liability of a third party for the cost of medical assistance
paid on behalf of the recipient. When an action or claim is brought
against a third party by a medical assistance recipient, any payment,
settlement or compromise of the action or claim, or any court award
or judgment, is subject to the recovery right of the department of
medicaid or county department.
Except
in the case of a medical assistance recipient who receives medical
assistance through a medicaid managed care organization, the
The

department's
or county department's claim shall not exceed the amount of medical
assistance paid by the department or county department on behalf of
the recipient. A payment, settlement, compromise, judgment, or award
that excludes the cost of medical assistance paid for by the
department or county department shall not preclude a department from
enforcing its rights under this section.

(B)(1)
In the case of a medical assistance recipient who receives medical
assistance through a medicaid managed care organization that has a
capitation agreement with a provider, the amount of the department's
or county department's claim shall be the amount the medicaid managed
care organization would have paid in the absence of a capitation
agreement.

(2)
In the case of a medical assistance recipient who receives medical
assistance through a medicaid managed care organization that does not
have a capitation agreement with a provider, the amount of the
department's or county department's claim shall be the amount the
medicaid managed care organization pays for medical assistance
rendered to the recipient, even if that amount is more than the
amount the department or county department pays to the medicaid
managed care organization for the recipient's medical assistance.

(C)
(B)

A medical assistance recipient, and the recipient's attorney, if any,
shall cooperate with the departments. In furtherance of this
requirement, the medical assistance recipient, or the recipient's
attorney, if any, shall, not later than thirty days after initiating
informal recovery activity or filing a legal recovery action against
a third party, provide written notice of the activity or action to
the department of medicaid or county department if it has paid for
medical assistance under a medical assistance program.

(D)
(C)

The written notice that must be given under division
(C)
(B)

of this section shall disclose the identity and address of any third
party against whom the medical assistance recipient has or may have a
right of recovery.

(E)
(D)

No settlement, compromise, judgment, or award or any recovery in any
action or claim by a medical assistance recipient where the
department or county department has a right of recovery shall be made
final without first giving the department or county department
written notice as described in division
(C)
(B)

of this section and a reasonable opportunity to perfect its rights of
recovery. If the department or county department is not given the
appropriate written notice, the medical assistance recipient and, if
there is one, the recipient's attorney, are liable to reimburse the
department or county department for the recovery received to the
extent of medical assistance payments made by the department or
county department.

(F)
(E)

The department or county department shall be permitted to enforce its
recovery rights against the third party even though it accepted prior
payments in discharge of its rights under this section if, at the
time the department or county department received such payments, it
was not aware that additional medical expenses had been incurred but
had not yet been paid by the department or county department. The
third party becomes liable to the department or county department as
soon as the third party is notified in writing of the valid claims
for recovery under this section.

(G)(1)
(F)(1)

Subject to division
(G)(2)
(F)(2)

of this section, the right of recovery of the department or county
department does not apply to that portion of any judgment, award,
settlement, or compromise of a claim, to the extent of attorneys'
fees, costs, or other expenses incurred by a medical assistance
recipient in securing the judgment, award, settlement, or compromise,
or to the extent of medical, surgical, and hospital expenses paid by
such recipient from the recipient's own resources.

(2)
Reasonable attorneys' fees, not to exceed one-third of the total
judgment, award, settlement, or compromise, plus costs and other
expenses incurred by the medical assistance recipient in securing the
judgment, award, settlement, or compromise, shall first be deducted
from the total judgment, award, settlement, or compromise. After
fees, costs, and other expenses are deducted from the total judgment,
award, settlement, or compromise, there shall be a rebuttable
presumption that the department of medicaid or county department
shall receive no less than one-half of the remaining amount, or the
actual amount of medical assistance paid, whichever is less. A party
may rebut the presumption in accordance with division
(L)(1)
(K)(1)
,
(2), or (3) of this section, as applicable.

(H)
(G)

A right of recovery created by this section may be enforced
separately or jointly by the department of medicaid or county
department. To enforce its recovery rights, the department or county
department may do any of the following:

(1)
Intervene or join in any action or proceeding brought by the medical
assistance recipient or on the recipient's behalf against any third
party who may be liable for the cost of medical assistance paid;

(2)
Institute and pursue legal proceedings against any third party who
may be liable for the cost of medical assistance paid;

(3)
Initiate legal proceedings in conjunction with any injured, diseased,
or disabled medical assistance recipient or the recipient's attorney
or representative.

(I)
(H)

A medical assistance recipient shall not assess attorney fees, costs,
or other expenses against the department of medicaid or a county
department when the department or county department enforces its
right of recovery created by this section.

(J)
(I)

The right of recovery given to the department under this section
includes payments made by a third party under contract with a person
having a duty to support.

(K)
(J)

The department of medicaid may assign to a medical assistance
provider the right of recovery given to the department under this
section with respect to any claim for which the department has
notified the provider that the department intends to recoup the
department's prior payment for the claim.

(L)(1)
(K)(1)

Prior to any payment to the department or a county department
pursuant to the department's or county department's right of recovery
under this section, a party that desires to rebut the presumption in
division
(G)
(F)

of this section shall submit to the department or county department a
request for a hearing in accordance with the procedure the department
establishes in rules required by division
(O)
(N)

of this section. The amount sought by the department or county
department shall be held in escrow or in an interest on lawyers'
trust account until the hearing examiner renders a decision or the
case is otherwise concluded. A party successfully rebuts the
presumption by a showing of clear and convincing evidence that a
different allocation is warranted.

(2)
A medical assistance recipient who has repaid money, on or after
September 29, 2007, to the department or a county department pursuant
to the department's or county department's right of recovery under
this section, section 5160.38 of the Revised Code, or former section
5101.58 or 5101.59 of the Revised Code may request a hearing to rebut
the presumption in division
(G)
(F)

of this section. The request shall be made in accordance with the
procedure the department establishes for this purpose in rules
required by division
(O)
(N)

of this section. It must be made not later than one hundred eighty
days after September 29, 2015, or ninety days after the payment is
made, whichever is later. A party successfully rebuts the presumption
by a showing of clear and convincing evidence that a different
allocation is warranted.

(3)
A medical assistance recipient who has repaid money, between April 6,
2007 and September 28, 2007, to the department or a county department
pursuant to the department's or county department's right of recovery
under this section, section 5160.38 of the Revised Code, or former
section 5101.58 or 5101.59 of the Revised Code may request a hearing
to rebut the presumption in division
(G)
(F)

of this section. The request shall be made not later than one hundred
eighty days after
the
effective date of this amendment
September
30, 2025,
in
accordance with the procedure the department establishes for this
purpose in rules required by division
(O)
(N)

of this section. The presumption is successfully rebutted if the
requestor demonstrates by clear and convincing evidence that a
different allocation is warranted.

(4)
With respect to a hearing requested under division
(L)(1)
(K)(1)
,
(2), or (3) of this section, all of the following are the case:

(a)
The hearing examiner may consider, but is not bound by the allocation
of, medical expenses specified in a settlement agreement between the
medical assistance recipient and the relevant third party;

(b)
The department or county department may raise affirmative defenses
during the hearing, including the existence of a prior settlement
with the medical assistance recipient, the doctrine of accord and
satisfaction, or the common law principle of res judicata;

(c)
If the parties agree, live testimony shall not be presented at the
hearing;

(d)
The hearing may be governed by rules adopted under section 5160.02 of
the Revised Code. If such rules are adopted, Chapter 119. of the
Revised Code applies to the hearing only to the extent specified in
those rules;

(e)
The hearing examiner's decision is binding on the department or
county department and the medical assistance recipient unless the
decision is reversed or modified on appeal to the medicaid director
as described in division
(M)
(L)

of this section;

(f)
A request for a hearing may be submitted by any of the following:

(i)
The medical assistance recipient;

(ii)
The medical assistance recipient's authorized representative;

(iii)
The executor or administrator of a medical assistance recipient's
estate authorized to make or pursue a request;

(iv)
A court-appointed guardian;

(v)
An attorney who has been directly retained by the medical assistance
recipient, or the recipient's parent, legal guardian, or
court-appointed guardian.

(M)(1)
(L)(1)

A medical assistance recipient who disagrees with a hearing
examiner's decision under division
(L)
(K)

of this section may file an administrative appeal with the medicaid
director in accordance with the procedure the department establishes
for this purpose in rules required by division
(O)
(N)

of this section. A hearing is not required during the administrative
appeal, but the director or the director's designee shall review the
hearing examiner's decision and any prior relevant administrative
action. After the review, the director or the director's designee
shall affirm, modify, remand, or reverse the hearing decision. A
decision made under this division is final and binding on the
department or county department and the medical assistance recipient
unless it is reversed or modified on appeal to a court of common
pleas as described in division
(N)
(M)

of this section.

(2)
An administrative appeal may be governed by rules adopted under
section 5160.02 of the Revised Code. If such rules are adopted,
Chapter 119. of the Revised Code applies to an administrative appeal
only to the extent specified in those rules.

(N)
(M)

A party to an administrative appeal described in division
(M)
(L)

of this section may file an appeal with a court of common pleas in
accordance with section 119.12 of the Revised Code.

(O)
(N)

The medicaid director shall adopt rules under section 5160.02 of the
Revised Code as necessary to implement this section, including rules
establishing procedures a party may use to request a hearing under
division
(L)(1)
(K)(1)
,
(2), or (3) of this section or an administrative appeal under
division
(M)(1)
(L)(1)

of this section. The rules shall be adopted in accordance with
Chapter 119. of the Revised Code.

(P)
(O)

Divisions
(L)
(K)

to
(N)
(M)

of this section are remedial in nature and shall be liberally
construed by the courts of this state in accordance with section 1.11
of the Revised Code. Those divisions specify the sole remedy
available to a party who claims the department or a county department
has received or is to receive more money than entitled to receive
under this section, section 5160.38 of the Revised Code, or former
section 5101.58 or 5101.59 of the Revised Code.

Sec.
5160.371.
In
addition to the requirement of division
(C)
(B)

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.

Sec.
5160.40.
(A)
As used in this section, "business day" means any day of
the week excluding Saturday, Sunday, and a legal holiday, as defined
in section 1.14 of the Revised Code.

(B)
Subject to
divisions

division

(C)

and (D)

of this section, a third party shall do all of the following:

(1)
Accept the department of medicaid's right of recovery under section
5160.37 of the Revised Code and the assignment of rights to the
department that are described in section 5160.38 of the Revised Code;

(2)
Respond to an inquiry by the department regarding a claim for payment
of a medical item or service that was submitted to the third party
not later than six years after the date of the provision of such
medical item or service;

(3)
Respond to the department's request for payment of a claim described
in division (B)(2) of this section not later than sixty business days
after receipt of written proof of the claim, either by paying the
claim or issuing a written denial to the department;

(4)
Not charge a fee to do either of the following for a claim described
in division (B)(2) of this section:

(a)
Determine whether the claim should be paid;

(b)
Process the claim.

(5)
Pay a claim described in division (B)(2) of this section;

(6)
Not deny a claim submitted by the department solely on the basis of
the date of submission of the claim, type or format of the claim
form, or a failure by the medical assistance recipient who is the
subject of the claim to present proper documentation of coverage at
the time of service, if both of the following have occurred:

(a)
The claim was submitted by the department not later than six years
after the date of the provision of the medical item or service.

(b)
An action by the department to enforce its right of recovery under
section 5160.37 of the Revised Code on the claim was commenced not
later than six years after the department's submission of the claim.

(7)
Consider the department's payment of a claim for a medical item or
service to be the equivalent of the medical assistance recipient
having obtained prior authorization for the item or service from the
third party;

(8)
Not deny a claim described in division (B)(7) of this section that is
submitted by the department solely on the basis of the medical
assistance recipient's failure to obtain prior authorization for the
medical item or service.

(C)

For
purposes of the requirements in division (B) of this section, a third
party shall treat a medicaid managed care organization as the
department for a claim if the individual who is the subject of the
claim received a medical item or service through a medicaid managed
care organization and the department has assigned its right of
recovery for the claim to the medicaid managed care organization.
Even if the department assigned its right of recovery to a medicaid
managed care organization, the department may, beginning one year
from the date the organization paid the claim, recoup from a third
party an amount that was assigned to the organization but not
collected.

(D)

If the department of medicaid, as permitted by division
(K)
(J)

of section 5160.37 of the Revised Code, assigns to a medical
assistance provider the department's right of recovery for a claim
for which it has notified the provider that it intends to recoup its
prior payment for a claim, a third party shall treat the provider as
the department and shall pay the provider the greater of the
following:

(1)
The amount the department intends to recoup from the provider for the
claim.

(2)
If the third party and the provider have an agreement that requires
the third party to pay the provider at the time the provider presents
the claim to the third party, the amount that is to be paid under
that agreement.

(E)
(D)

The time limitations associated with the requirements in divisions
(B)(2) and (6) of this section apply only to submissions of claims
to, and payments of claims by, a health insurer to which the "Social
Security Act," section 1902(a)(25)(I), 42 U.S.C.
1396a(a)(25)(I), applies.

Sec.
5162.01.
(A)
As used in the Revised Code:

(1)
"Medicaid" and "medicaid program" mean the
program of medical assistance established by Title XIX of the "Social
Security Act," 42 U.S.C. 1396 et seq., including any medical
assistance provided under the medicaid state plan or a federal
medicaid waiver granted by the United States secretary of health and
human services.

(2)
"Medicare" and "medicare program" mean the
federal health insurance program established by Title XVIII of the
"Social Security Act," 42 U.S.C. 1395 et seq.

(B)
As used in this chapter:

(1)
"Exchange" has the same meaning as in 45 C.F.R. 155.20.

(2)
"Expansion eligibility group" has the same meaning as in
section 5163.01 of the Revised Code.

(3)
"Federal financial participation" has the same meaning as
in section 5160.01 of the Revised Code.

(4)
"Federal poverty line" means the official poverty line
defined by the United States office of management and budget based on
the most recent data available from the United States bureau of the
census and revised by the United States secretary of health and human
services pursuant to the "Omnibus Budget Reconciliation Act of
1981," section 673(2), 42 U.S.C. 9902(2).

(5)
"Healthcheck" has the same meaning as in section 5164.01 of
the Revised Code.

(6)
"Healthy start component" means the component of the
medicaid program that covers pregnant women and children and is
identified in rules adopted under section 5162.02 of the Revised Code
as the healthy start component.

(7)
"Home and community-based services" means services provided
under a home and community-based services medicaid waiver component.

(8)
"Home and community-based services medicaid waiver component"
has the same meaning as in section 5166.01 of the Revised Code.

(9)
"ICF/IID" has the same meaning as in section 5124.01 of the
Revised Code.

(10)
"Individualized education program" has the same meaning as
in section 3323.011 of the Revised Code.

(11)
"Medicaid managed care organization"
has
the same meaning as in section 5167.01 of the Revised Code
means
a managed care organization that, on the effective date of this
amendment, is under contract with the department of medicaid to
administer medicaid benefits to medicaid recipients
.

(12)

"Medicaid
MCO plan" has the same meaning as in section 5167.01 of the
Revised Code.

(13)

"Medicaid
provider" has the same meaning as in section 5164.01 of the
Revised Code.

(14)
(13)

"Medicaid services" has the same meaning as in section
5164.01 of the Revised Code.

(15)
(14)

"Medicaid waiver component" has the same meaning as in
section 5166.01 of the Revised Code;

(16)
(15)

"Nursing facility" and "nursing facility services"
have the same meanings as in section 5165.01 of the Revised Code.

(17)
(16)

"Ordering or referring only provider" means a medicaid
provider who orders, prescribes, refers, or certifies a service or
item reported on a claim for medicaid payment but does not bill for
medicaid services.

(18)
(17)

"Political subdivision" means a municipal corporation,
township, county, school district, or other body corporate and
politic responsible for governmental activities only in a
geographical area smaller than that of the state.

(19)
(18)

"Prescribed drug" has the same meaning as in section
5164.01 of the Revised Code.

(20)
(19)

"Provider agreement" has the same meaning as in section
5164.01 of the Revised Code.

(21)
(20)

"Qualified medicaid school provider" means the board of
education of a city, local, or exempted village school district, the
governing board of an educational service center, the governing
authority of a community school established under Chapter 3314. of
the Revised Code, and Ohio deaf and blind education services to which
both of the following apply:

(a)
It holds a valid provider agreement.

(b)
It meets all other conditions for participation in the medicaid
school component of the medicaid program established in rules
authorized by section 5162.364 of the Revised Code.

(22)
(21)

"State agency" means every organized body, office, or
agency, other than the department of medicaid, established by the
laws of the state for the exercise of any function of state
government.

(23)
(22)

"Vendor offset" means a reduction of a medicaid payment to
a medicaid provider to correct a previous, incorrect medicaid payment
to that provider.

Sec.
5162.021.
The
medicaid director shall adopt rules under sections 5160.02, 5162.02,
5163.02, 5164.02, 5165.02,
and

5166.02
,
and 5167.02

of the Revised Code as necessary to authorize the directors of other
state agencies to adopt rules regarding medicaid components, or
aspects of medicaid components, the other state agencies administer
pursuant to contracts entered into under section 5162.35 of the
Revised Code.

Sec.
5162.13.
(A)
On or before the first day of January of each year, the department of
medicaid shall complete a report on the effectiveness of the medicaid
program in meeting the health care needs of low-income pregnant
women, infants, and children. The report shall include all of the
following, delineated by race and ethnic group:

(1)
The estimated number of pregnant women, infants, and children
eligible for the program;

(2)
The actual number of eligible persons enrolled in the program;

(3)
The actual number of enrolled pregnant women categorized by estimated
gestational age at time of enrollment;

(4)
The average number of days between
the
following events:

(a)
A
a

pregnant
woman's application for medicaid and enrollment in the

fee-for-service
component of
medicaid
;

(b)
A pregnant woman's application for enrollment in a medicaid managed
care organization and enrollment in the managed care organization

program
.

The
information described in
divisions
(A)(4)(a) and (b)
division
(A)(4)

of this section shall also be delineated by county and the urban and
rural communities specified in rules adopted under section 3701.142
of the Revised Code.

(5)
The number of prenatal, postpartum, and child health visits;

(6)
The estimated number of enrolled women of child-bearing age who use a
tobacco product;

(7)
The estimated number of enrolled women of child-bearing age who
participate in a tobacco cessation program or who use a tobacco
cessation product;

(8)
The rates at which enrolled pregnant women receive addiction or
mental health services, progesterone therapy, and any other service
specified by the department;

(9)
A report on birth outcomes, including a comparison of low-birthweight
births and infant mortality rates of medicaid recipients with the
general female child-bearing and infant population in this state;

(10)
A comparison of the prenatal, delivery, and child health costs of the
program with such costs of similar programs in other states, where
available;

(11)
A report on performance data generated by the component of the state
innovation model (SIM) grant pertaining to episode-based payments for
perinatal care that was awarded to this state by the center for
medicare and medicaid innovation in the United States centers for
medicare and medicaid services;

(12)
A report on funds allocated for infant mortality reduction
initiatives in the urban and rural communities specified in rules
adopted under section 3701.142 of the Revised Code;

(13)
A report on the results of client responses to questions related to
pregnancy services and healthcheck that are asked by the personnel of
county departments of job and family services;

(14)

A
comparison of the performance of the fee-for-service component of
medicaid with the performance of each medicaid managed care
organization on perinatal health metrics;

(15)

A
report demonstrating cost savings resulting from program investments;

(16)
(15)

Beginning two years after April 30, 2024, a report on the medicaid
coverage of doula services required by section 5164.071 of the
Revised Code, including:

(a)
Outcomes related to maternal health and maternal morbidity;

(b)
Infant health outcomes;

(c)
The average costs of providing doula services to mothers and infants;

(d)
Estimated cost increases or savings as a result of providing doula
coverage.

(B)
The department shall submit the report to the general assembly in
accordance with section 101.68 of the Revised Code. The department
also shall make the report available to the public.

(C)
The department shall provide to the legislative service commission a
copy of the data used to calculate the information required in the
report under division
(A)(16)
(A)(15)

of this section.

Sec.
5162.1310.
(A)
The department of medicaid shall periodically evaluate the success
that members of the expansion eligibility group have with the
following:

(1)
Obtaining employer-sponsored health insurance coverage;

(2)
Improving health conditions that would otherwise prevent or inhibit
stable employment;

(3)
Improving the conditions of their employment, including duration and
hours of employment.

(B)

For
the purpose of aiding the department's evaluations under this
section, medicaid managed care organizations shall collect and submit
to the department relevant data about members of the expansion
eligibility group who are enrolled in the organizations' medicaid MCO
plans. The department may request that a medicaid managed care
organization collect and submit to the department additional data the
department needs for the evaluation.

(C)

The
department shall complete a report for each evaluation conducted
under this section. The director shall provide a copy of the report
to the general assembly in accordance with section 101.68 of the
Revised Code.

Sec.
5162.73.
(A)
As used in this section:

(1)
"Administrative services organization" or "ASO"
means an entity contracted by the department of medicaid to perform
administrative functions related to the medicaid program, including
claims processing, prior authorization review, provider credentialing
and recruitment, customer service and grievance resolution, and data
analytics and utilization monitoring. An "administrative
services organization" or "ASO" is not a managed care
organization and is a nonfinancial risk-bearing entity.

(2)
"Care coordination" means a set of services provided by
physicians, nurses, community health workers, behavioral health
providers, and other licensed health care providers to ensure that
patients receive appropriate, timely, and culturally responsive care
across the continuum of health services.

(3)
"Financial risk-bearing medicaid managed care organization"
means a medicaid managed care organization that contracts with the
department of medicaid to provide administrative services on a
financial risk-bearing basis which entails payment on a capitated
basis and incentivizes the organization to maximize internal profit
by restricting care at the expense of medicaid recipients.

(4)
"Managed fee-for-service" means a medicaid delivery model
that combines direct payment to medicaid providers for each encounter
or service provided to a medicaid recipient with periodic capitated
payments for a range of additional indirect services, including care
coordination and quality improvement.

(B)(1)
Not later than thirty days after the effective date of this section,
the medicaid director shall convene a workgroup to establish a
transition plan concerning the termination of the care management
system established under the former version of section 5167.03 of the
Revised Code that existed immediately prior to the effective date of
this section.

(2)
The workgroup shall consist of medicaid recipients; medicaid
providers, including dentists, hospital representatives, and nursing
home representatives; representatives of the Ohio association of
community health centers; representatives of the Ohio association of
area agencies on aging; and other stakeholders as determined by the
director. Workgroup members shall be evenly distributed from the
following regions of this state as follows:

(a)
Region 1: Ashtabula, Cuyahoga, Geauga, Lake, Lorain;

(b)
Region 2: Allen, Auglaize, Defiance, Erie, Fulton, Hancock, Henry,
Huron, Lucas, Mercer, Ottawa, Paulding, Putnam, Sandusky, Seneca, Van
Wert, Williams, Wood;

(c)
Region 3: Athens, Belmont, Coshocton, Gallia, Guernsey, Harrison,
Hocking, Jackson, Jefferson, Lawrence, Meigs, Monroe, Morgan,
Muskingum, Noble, Perry, Pike, Ross, Scioto, Vinton, Washington;

(d)
Region 4: Adams, Brown, Butler, Clermont, Clinton, Hamilton,
Highland, Warren;

(e)
Region 5: Crawford, Delaware, Fairfield, Fayette, Franklin, Hardin,
Knox, Licking, Logan, Madison, Marion, Morrow, Pickaway, Union,
Wyandot;

(f)
Region 6: Ashland, Carroll, Columbiana, Holmes, Mahoning, Medina,
Portage, Richland, Stark, Summit, Trumbull, Tuscarawas, Wayne;

(g)
Region 7: Champaign, Clark, Darke, Greene, Miami, Montgomery, Preble,
Shelby.

(3)
The workgroup shall meet to establish recommendations for terminating
the care management system and transitioning medicaid recipients to
an ASO-based model. In establishing recommendations for the
transition, the workgroup shall consider all of the following:

(a)
The number of administrative services organizations the department of
medicaid should contract with to perform administrative functions
related to the medicaid program following termination of the care
management system;

(b)
The medicaid program responsibilities that will be overseen by
administrative services organizations;

(c)
The medicaid payment rate for services provided by medicaid providers
under the managed fee-for-service component of the medicaid program,
including whether providers should receive medicaid payment in an
amount that equals one hundred per cent of the medicare payment rate
for similar services;

(d)
How cost savings realized from the termination of the care management
system will be redistributed within the medicaid program;

(e)
How to structure the care coordination component of the medicaid
program, including how to transition care coordination from medicaid
managed care organizations to medicaid providers and how to provide
providers with requisite training. In considering the structure of
the care coordination component of the medicaid program, the
workgroup shall delineate the scope of care coordination activities
that primary care providers will be responsible for overseeing and
determine a capitated payment rate for care coordination services
provided by medicaid providers.

(f)
How to structure and monitor office-based quality improvement
activities. In considering quality improvement activities, the
workgroup shall consider including a mechanism for determining
high-impact clinical goals for improvement, creation of metrics to
measure quality improvements, and establishing incentives for
provider participation in quality improvement activities that include
capitated payments, compensation for achieving intended outcomes, and
continuing medical education credits.

(4)
Not later than twelve months after the workgroup is convened, the
workgroup shall submit a report to the medicaid director detailing
the workgroup's recommendations for terminating the care management
system.

(C)
Upon receipt of the report submitted by the workgroup, the director
shall do all of the following:

(1)
Adopt rules in accordance with Chapter 119. of the Revised Code to
implement this section;

(2)
Through a procurement process, select one or more administrative
services organizations as a replacement for the care management
system. As part of the procurement process, the director shall do all
of the following:

(a)
Accept applications from entities seeking to become an administrative
services organization;

(b)
Establish eligibility criteria an entity must meet in order to become
an administrative services organization;

(c)
Not later than one hundred eighty days after receipt of the
workgroup's report, select and contract with one or more
administrative services organizations.

(3)
Not later than one hundred eighty days after receipt of the
workgroup's report, seek all necessary federal approval from the
United States centers for medicare and medicaid services to implement
this section.

(D)
Beginning on the first day of the fiscal biennium that begins after
the medicaid director enters into contracts with selected
administrative services organizations under division (C)(2) of this
section, the director shall not renew any existing contracts or
agreements between the department of medicaid and a financial
risk-bearing medicaid managed care organization or enter into a new
contract or agreement with a financial risk-bearing medicaid managed
care organization.

(E)(1)
As soon as practicable after the first day of that fiscal biennium,
the department shall transition all medicaid recipients enrolled in
financial risk-bearing medicaid managed care organization plans to
the fee-for-service component of the medicaid program or to the
managed fee-for-service component in accordance with the rules
adopted under division (C)(1) of this section.

(2)
The department shall prepare and distribute guidance materials to
assist individuals transitioning from a medicaid managed care
organization as described in division (E)(1) of this section.

(F)
Upon completing the transition described in division (E) of this
section, the medicaid director shall terminate all contracts or
agreements entered into between the department and financial
risk-bearing medicaid managed care organizations. The director shall
provide financial risk-bearing medicaid managed care organizations
with at least thirty days' notice prior to terminating a contract or
agreement under this section. Each financial risk-bearing medicaid
managed care organization shall ensure that medicaid providers
receive payment for incurred but not reported expenses prior to the
financial risk-bearing medicaid managed care organization's
termination from participation in the care management system.

(G)
The medicaid director shall prepare and submit an annual report to
the general assembly and the governor detailing the actions the
department of medicaid takes in accordance with this section. The
report shall include all of the following:

(1)
Medicaid program financial performance metrics related to the
transition from the care management system, including the amount of
total savings experienced by the medicaid program as a result of the
transition;

(2)
Clinical outcomes for and resource utilization by medicaid recipients
who transition from the care management system to the ASO system;

(3)
Any other information that the director considers relevant regarding
the transition.

(H)
The medicaid director shall ensure that one hundred per cent of all
cost savings realized as a result of terminating the care management
system are reinvested into the medicaid program.

(I)
In enacting this section, it is the intent of the general assembly to
terminate the care management system established under the former
version of section 5167.03 of the Revised Code that existed
immediately prior to the effective date of this section.

Sec.

5162.73

5162.74
.

(A)
The
Department

department

of

Medicaid

medicaid

may
establish and administer a program to provide dental services to
pregnant
Medicaid

medicaid

recipients.
If the program is established, all of the following shall apply:

(1)
Medicaid recipients who are members of the group described in section
5163.06 of the Revised Code shall be eligible to receive two dental
cleanings per year.

(2)
The
Department

department

shall
give priority to those
Medicaid

medicaid

recipients
residing in areas of the state with high preterm birth rates.

(3)
The
Department

department

shall
inform
Medicaid

medicaid

recipients
about the program and market the program to
Medicaid

medicaid

recipients.

(B)
The
Department

department

of

Medicaid

medicaid

shall
establish reimbursement rates for entities that educate
Medicaid

medicaid

recipients
about the importance of prenatal and postnatal dental care as part of
the program described in section 3701.615 of the Revised Code,
including reimbursement rates for all or part of the costs associated
with developing and distributing educational materials related to the
importance of prenatal and postnatal dental care.

Sec.
5164.01.
As
used in this chapter:

(A)
"Adjudication" has the same meaning as in section 119.01 of
the Revised Code.

(B)
"Behavioral health redesign" means revisions to the
medicaid program's coverage of community behavioral health services
beginning July 1, 2017, including revisions that update medicaid
billing codes and payment rates for community behavioral health
services.

(C)
"Clean claim" has the same meaning as in 42 C.F.R.
447.45(b).

(D)
"Community behavioral health services" means both of the
following:

(1)
Alcohol and drug addiction services provided by a community addiction
services provider, as defined in section 5119.01 of the Revised Code;

(2)
Mental health services provided by a community mental health services
provider, as defined in section 5119.01 of the Revised Code.

(E)
"Early and periodic screening, diagnostic, and treatment
services" has the same meaning as in the "Social Security
Act," section 1905(r), 42 U.S.C. 1396d(r).

(F)
"Federal financial participation" has the same meaning as
in section 5160.01 of the Revised Code.

(G)
"Federal poverty line" has the same meaning as in section
5162.01 of the Revised Code.

(H)
"Healthcheck" means the component of the medicaid program
that provides early and periodic screening, diagnostic, and treatment
services.

(I)
"Home and community-based services medicaid waiver component"
has the same meaning as in section 5166.01 of the Revised Code.

(J)
"Hospital" has the same meaning as in section 3727.01 of
the Revised Code.

(K)
"ICDS participant" means a dual eligible individual who
participates in the integrated care delivery system.

(L)
"ICF/IID" has the same meaning as in section 5124.01 of the
Revised Code.

(M)
"Integrated care delivery system" and "ICDS" mean
the demonstration project authorized by section 5164.91 of the
Revised Code.

(N)
"Mandatory services" means the health care services and
items that must be covered by the medicaid state plan as a condition
of the state receiving federal financial participation for the
medicaid program.

(O)

"Medicaid
managed care organization" has the same meaning as in section
5167.01 of the Revised Code.

(P)

"Medicaid
provider" means a person or government entity with a valid
provider agreement to provide medicaid services to medicaid
recipients. To the extent appropriate in the context, "medicaid
provider" includes a person or government entity applying for a
provider agreement, a former medicaid provider, or both.

(Q)
(P)

"Medicaid services" means either or both of the following:

(1)
Mandatory services;

(2)
Optional services that the medicaid program covers.

(R)
(Q)

"Nursing facility" has the same meaning as in section
5165.01 of the Revised Code.

(S)
(R)

"Optional services" means the health care services and
items that may be covered by the medicaid state plan or a federal
medicaid waiver and for which the medicaid program receives federal
financial participation.

(T)
(S)

"Prescribed drug" has the same meaning as in 42 C.F.R.
440.120.

(U)
(T)

"Provider agreement" means an agreement to which all of the
following apply:

(1)
It is between a medicaid provider and the department of medicaid;

(2)
It provides for the medicaid provider to provide medicaid services to
medicaid recipients;

(3)
It complies with 42 C.F.R. 431.107(b).

(V)
(U)

"State plan home and community-based services" means home
and community-based services that, as authorized by section 1915(i)
of the "Social Security Act," 42 U.S.C. 1396n(i), may be
covered by the medicaid program pursuant to an amendment to the
medicaid state plan.

(W)
(V)

"Terminal distributor of dangerous drugs" has the same
meaning as in section 4729.01 of the Revised Code.

Sec.
5164.38.
(A)
As used in this section:

(1)
"Party" has the same meaning as in division (G) of section
119.01 of the Revised Code.

(2)
"Revalidate" means to approve a medicaid provider's
continued enrollment as a medicaid provider in accordance with the
revalidation process established in rules authorized by section
5164.32 of the Revised Code.

(B)
This section does not apply to
either
of the following:

(1)
Any action taken or decision made by the department of medicaid with
respect to entering into or refusing to enter into a contract with a
managed care organization pursuant to section 5167.10 of the Revised
Code;

(2)
Any
any

action
taken by the department under division (D)(2) of section 5124.60,
division (D)(1) or (2) of section 5124.61, or sections 5165.60 to
5165.89 of the Revised Code.

(C)
Except as provided in division (E) of this section and section
5164.58 of the Revised Code, the department shall do any of the
following by issuing an order pursuant to an adjudication conducted
in accordance with Chapter 119. of the Revised Code:

(1)
Refuse to enter into a provider agreement with a medicaid provider;

(2)
Refuse to revalidate a medicaid provider's provider agreement;

(3)
Suspend or terminate a medicaid provider's provider agreement;

(4)
Take any action based upon a final fiscal audit of a medicaid
provider.

(D)
Any party who is adversely affected by the issuance of an
adjudication order under division (C) of this section may appeal to
the court of common pleas in accordance with section 119.12 of the
Revised Code.

(E)
The department is not required to comply with division (C)(1), (2),
or (3) of this section whenever any of the following occur:

(1)
The terms of a provider agreement require the medicaid provider to
hold a license, permit, or certificate or maintain a certification
issued by an official, board, commission, department, division,
bureau, or other agency of state or federal government other than the
department of medicaid, and the license, permit, certificate, or
certification has been denied, revoked, not renewed, suspended, or
otherwise limited.

(2)
The terms of a provider agreement require the medicaid provider to
hold a license, permit, or certificate or maintain certification
issued by an official, board, commission, department, division,
bureau, or other agency of state or federal government other than the
department of medicaid, and the provider has not obtained the
license, permit, certificate, or certification.

(3)
The medicaid provider's application for a provider agreement is
denied, or the provider's provider agreement is terminated or not
revalidated, because of or pursuant to any of the following:

(a)
The termination, refusal to renew, or denial of a license, permit,
certificate, or certification by an official, board, commission,
department, division, bureau, or other agency of this state other
than the department of medicaid, notwithstanding the fact that the
provider may hold a license, permit, certificate, or certification
from an official, board, commission, department, division, bureau, or
other agency of another state;

(b)
Division (D) or (E) of section 5164.35 of the Revised Code;

(c)
The provider's termination, suspension, or exclusion from the
medicare program or from another state's medicaid program and, in
either case, the termination, suspension, or exclusion is binding on
the provider's participation in the medicaid program in this state;

(d)
The provider's pleading guilty to or being convicted of a criminal
activity materially related to either the medicare or medicaid
program;

(e)
The provider or its owner, officer, authorized agent, associate,
manager, or employee having been convicted of one of the offenses
that caused the provider's provider agreement to be suspended
pursuant to section 5164.36 of the Revised Code;

(f)
The provider's failure to provide the department the national
provider identifier assigned the provider by the national provider
system pursuant to 45 C.F.R. 162.408.

(4)
The medicaid provider's application for a provider agreement is
denied, or the provider's provider agreement is terminated or
suspended, as a result of action by the United States department of
health and human services and that action is binding on the
provider's medicaid participation.

(5)
The medicaid provider's provider agreement and medicaid payments to
the provider are suspended under section 5164.36 or 5164.37 of the
Revised Code.

(6)
The medicaid provider's application for a provider agreement is
denied because the provider's application was not complete;

(7)
The medicaid provider's provider agreement is converted under section
5164.32 of the Revised Code from a provider agreement that is not
time-limited to a provider agreement that is time-limited.

(8)
Unless the medicaid provider is a nursing facility or ICF/IID, the
provider's provider agreement is not revalidated pursuant to division
(B)(1) of section 5164.32 of the Revised Code.

(9)
The medicaid provider's provider agreement is suspended, terminated,
or not revalidated because of either of the following:

(a)
Any reason authorized or required by one or more of the following: 42
C.F.R. 455.106, 455.23, 455.416, 455.434, or 455.450;

(b)
The provider has not billed or otherwise submitted a medicaid claim
for two years or longer.

(F)
In the case of a medicaid provider described in division (E)(3)(f),
(6), (7), or (9)(b) of this section, the department may take its
action by sending a notice explaining the action to the provider. The
notice shall be sent to the medicaid provider's address on record
with the department. The notice may be sent by regular mail.

(G)
The department may withhold payments for medicaid services rendered
by a medicaid provider during the pendency of proceedings initiated
under division (C)(1), (2), or (3) of this section. If the
proceedings are initiated under division (C)(4) of this section, the
department may withhold payments only to the extent that they equal
amounts determined in a final fiscal audit as being due the state.
This division does not apply if the department fails to comply with
section 119.07 of the Revised Code, requests a continuance of the
hearing, or does not issue a decision within thirty days after the
hearing is completed. This division does not apply to nursing
facilities and ICFs/IID.

Sec.
5164.46.
(A)
As used in this section, "electronic claims submission process"
means any of the following:

(1)
Electronic interchange of data;

(2)
Direct entry of data through an internet-based mechanism implemented
by the department of medicaid;

(3)
Any other process for the electronic submission of claims that is
specified in rules adopted under section 5162.02 of the Revised Code.

(B)
Not later than January 1, 2013, and except as provided in division
(C) of this section, each medicaid provider shall do both of the
following:

(1)
Use only an electronic claims submission process to submit to the
department of medicaid claims for medicaid payment for medicaid
services provided to medicaid recipients;

(2)
Arrange to receive medicaid payment from the department by means of
electronic funds transfer.

(C)
Division (B) of this section does not apply to any of the following:

(1)
A nursing facility;

(2)
An ICF/IID;

(3)

A
medicaid managed care organization;

(4)

Any
other medicaid provider or type of medicaid provider designated in
rules adopted under section 5162.02 of the Revised Code.

(D)
The department shall not process a medicaid claim submitted on or
after January 1, 2013, unless the claim is submitted through an
electronic claims submission process in accordance with this section.

Sec.
5164.74.
The
medicaid director shall adopt rules under section 5164.02 of the
Revised Code governing the calculation and payment of, and the
allocation of payments for, graduate medical education costs
associated with medicaid services rendered to medicaid recipients
.
Subject to section 5164.741 of the Revised Code, the rules shall
provide for payment of graduate medical education costs associated
with medicaid services rendered to medicaid recipients, including
recipients enrolled in a medicaid managed care organization,

that the department of medicaid determines are allowable and
reasonable.

Sec.
5164.751.
(A)
As used in this section, "state maximum allowable cost"
means the per unit amount the medicaid program pays a terminal
distributor of dangerous drugs for a prescribed drug included in the
state maximum allowable cost program established under division (B)
of this section. "State maximum allowable cost" excludes
dispensing fees and copayments, coinsurance, or other cost-sharing
charges, if any.

(B)

Subject
to section 5167.123 of the Revised Code, the
The

medicaid
director shall establish a state maximum allowable cost program for
purposes of managing medicaid payments to terminal distributors of
dangerous drugs for prescribed drugs identified by the director
pursuant to this division. The director shall do all of the following
with respect to the program:

(1)
Identify and create a list of prescribed drugs to be included in the
program.

(2)
Update the list of prescribed drugs described in division (B)(1) of
this section on a weekly basis.

(3)
Review the state maximum allowable cost for each prescribed drug
included on the list described in division (B)(1) of this section on
a weekly basis.

Sec.
5166.01.
As
used in this chapter:

"209(b)
option" means the option described in section 1902(f) of the
"Social Security Act," 42 U.S.C. 1396a(f), under which the
medicaid program's eligibility requirements for aged, blind, and
disabled individuals are more restrictive than the eligibility
requirements for the supplemental security income program.

"Administrative
agency" means, with respect to a home and community-based
services medicaid waiver component, the department of medicaid or, if
a state agency or political subdivision contracts with the department
under section 5162.35 of the Revised Code to administer the
component, that state agency or political subdivision.

"Care
management system" has the same meaning as in section 5167.01 of
the Revised Code.

"Dual
eligible individual" has the same meaning as in section 5160.01
of the Revised Code.

"Enrollee"
has the same meaning as in section 5167.01 of the Revised Code.

"Expansion
eligibility group" has the same meaning as in section 5163.01 of
the Revised Code.

"Federal
poverty line" has the same meaning as in section 5162.01 of the
Revised Code.

"Home
and community-based services medicaid waiver component" means a
medicaid waiver component under which home and community-based
services are provided as an alternative to hospital services, nursing
facility services, or ICF/IID services.

"Hospital"
has the same meaning as in section 3727.01 of the Revised Code.

"Hospital
long-term care unit" has the same meaning as in section 5168.40
of the Revised Code.

"ICDS
participant" has the same meaning as in section 5164.01 of the
Revised Code.

"ICF/IID"
and "ICF/IID services" have the same meanings as in section
5124.01 of the Revised Code.

"Integrated
care delivery system" and "ICDS" have the same
meanings as in section 5164.01 of the Revised Code.

"Level
of care determination" means a determination of whether an
individual needs the level of care provided by a hospital, nursing
facility, or ICF/IID and whether the individual, if determined to
need that level of care, would receive hospital services, nursing
facility services, or ICF/IID services if not for a home and
community-based services medicaid waiver component.

"Medicaid
buy-in for workers with disabilities program" has the same
meaning as in section 5163.01 of the Revised Code.

"Medicaid
MCO plan" has the same meaning as in section 5167.01 of the
Revised Code.

"Medicaid
provider" has the same meaning as in section 5164.01 of the
Revised Code.

"Medicaid
services" has the same meaning as in section 5164.01 of the
Revised Code.

"Medicaid
waiver component" means a component of the medicaid program
authorized by a waiver granted by the United States department of
health and human services under section 1115 or 1915 of the "Social
Security Act," 42 U.S.C. 1315 or 1396n. "Medicaid waiver
component" does not include the care management system or
services delivered under a prepaid inpatient health plan, as defined
in 42 C.F.R. 438.2.

"Medically
fragile child" means an individual who is under eighteen years
of age, has intensive health care needs, and is considered blind or
disabled under section 1614(a)(2) or (3) of the "Social Security
Act," 42 U.S.C. 1382c(a)(2) or (3).

"Nursing
facility" and "nursing facility services" have the
same meanings as in section 5165.01 of the Revised Code.

"Ohio
home care waiver program" means the home and community-based
services medicaid waiver component that is known as Ohio home care
and was created pursuant to section 5166.11 of the Revised Code.

"Provider
agreement" has the same meaning as in section 5164.01 of the
Revised Code.

"Residential
treatment facility" means a residential facility licensed by the
department of
mental

behavioral

health

and
addiction services
under
section 5119.34 of the Revised Code, or an institution certified by
the department of children and youth under section 5103.03 of the
Revised Code, that serves children and either has more than sixteen
beds or is part of a campus of multiple facilities or institutions
that, combined, have a total of more than sixteen beds.

"Skilled
nursing facility" has the same meaning as in section 5165.01 of
the Revised Code.

Sec.
5166.40.
(A)
As used in sections 5166.40 to 5166.409 of the Revised Code:

(1)
"Adult" means an individual who is at least eighteen years
of age.

(2)
"Buckeye account" means a modified health savings account
established under section 5166.402 of the Revised Code.

(3)
"Contribution" means the amounts that an individual
contributes to the individual's buckeye account and are contributed
to the account on the individual's behalf under divisions (C) and (D)
of section 5166.402 of the Revised Code. "Contribution"
does not mean the portion of an individual's buckeye account that
consists of medicaid funds deposited under division (B) of section
5166.402 of the Revised Code or section 5166.404 of the Revised Code.

(4)
"Core portion" means the portion of a healthy Ohio program
participant's buckeye account that consists of the following:

(a)
The amount of contributions to the account;

(b)
The amounts awarded to the account under divisions (C) and (D) of
section 5166.404 of the Revised Code.

(5)
"Eligible employer-sponsored health plan" has the same
meaning as in section 5000A(f)(2) of the "Internal Revenue Code
of 1986," 26 U.S.C. 5000A(f)(2).

(6)
"Healthy Ohio program" means the medicaid waiver component
established under sections 5166.40 to 5166.409 of the Revised Code
under which medicaid recipients specified in division (B) of this
section enroll in comprehensive health plans and contribute to
buckeye accounts.

(7)
"Healthy Ohio program debit swipe card" means a debit swipe
card issued by a managed care organization to a healthy Ohio program
participant under section 5166.403 of the Revised Code.

(8)
"Not-for-profit organization" means an organization that is
exempt from federal income taxation under section 501(a) and (c)(3)
of the "Internal Revenue Code of 1986," 26 U.S.C. 501(a)
and (c)(3).

(9)
"Ward of the state" means an individual who is a ward, as
defined in section 2111.01 of the Revised Code.

(10)
"Workforce development activity" and "local board"
have the same meanings as in section 6301.01 of the Revised Code.

(B)
The medicaid director shall establish a medicaid waiver component to
be known as the healthy Ohio program. Each adult medicaid recipient,
other than a ward of the state, determined to be eligible for
medicaid on the basis of either of the following shall participate in
the healthy Ohio program:

(1)
On the basis of being included in the category identified by the
department of medicaid as covered families and children;

(2)
On the basis of being included in the expansion eligibility group.

(C)
Except as provided in section 5166.406 of the Revised Code, a healthy
Ohio program participant shall not receive medicaid services under
the fee-for-service component of medicaid

or participate in the care management system
.

Sec.
5166.405.
(A)
A healthy Ohio program participant's participation in the program
shall cease if any of the following applies:

(1)
Unless the participant is pregnant, a monthly installment payment to
the participant's buckeye account is sixty days late.

(2)
The participant fails to submit documentation needed for a
redetermination of the participant's eligibility for medicaid before
the sixty-first day after the documentation is requested.

(3)
The participant becomes eligible for medicaid on a basis other than
being included in the category identified by the department of
medicaid as covered families and children or being included in the
expansion eligibility group.

(4)
The participant becomes a ward of the state.

(5)
The participant ceases to be eligible for medicaid.

(6)
The participant exhausts the annual or lifetime payout limit
specified in division (D) of section 5166.401 of the Revised Code.

(7)
The participant requests that the participant's participation be
terminated.

(B)
A healthy Ohio program participant who ceases to participate in the
program under division (A)(1) or (2) of this section may not resume
participation until the former participant pays the full amount of
the monthly installment payment or submits the documentation needed
for the former participant's medicaid eligibility redetermination.
The former participant shall not be transferred to the
fee-for-service component of medicaid
or
the care management system
as
a result of ceasing to participate in the healthy Ohio program under
division (A)(1) or (2) of this section.

(C)
Except as provided in section 5166.407 of the Revised Code, a healthy
Ohio program participant who ceases to participate in the program
shall be provided the contributions that are in the participant's
buckeye account at the time the participant ceases participation.

Sec.
5166.406.
If
a healthy Ohio program participant exhausts the annual or lifetime
payout limits specified in division (D) of section 5166.401 of the
Revised Code, the participant shall be transferred to the
fee-for-service component of medicaid

or the care management system
.
A participant who exhausts the annual payout limit for a year shall
resume participation in the healthy Ohio program at the beginning of
the immediately following year if division (B) of section 5166.40 of
the Revised Code continues to apply to the participant.

Sec.
5168.75.
As
used in sections 5168.75 to 5168.86 of the Revised Code:

(A)
"Basic health care services" means all of the services
listed in division (A)(1) of section 1751.01 of the Revised Code.

(B)

"Care
management system" has the same meaning as in section 5167.01 of
the Revised Code.

(C)

"Dual
eligible individual" has the same meaning as in section 5160.01
of the Revised Code.

(D)
(C)

"Franchise fee" means the fee imposed on health insuring
corporation plans under section 5168.76 of the Revised Code.

(E)
(D)

"Health insuring corporation" has the same meaning as in
section 1751.01 of the Revised Code, except it does not mean a
corporation that, pursuant to a policy, contract, certificate, or
agreement, pays for, reimburses, or provides, delivers, arranges for,
or otherwise makes available, only supplemental health care services
or only specialty health care services.

(F)
(E)

"Health insuring corporation plan" means a policy,
contract, certificate, or agreement of a health insuring corporation
under which the corporation pays for, reimburses, provides, delivers,
arranges for, or otherwise makes available basic health care
services. "Health insuring corporation plan" does not mean
any of the following:

(1)
A policy, contract, certificate, or agreement under which a health
insuring corporation pays for, reimburses, provides, delivers,
arranges for, or otherwise makes available only supplemental health
care services or only specialty health care services;

(2)
An approved health benefits plan described in 5 U.S.C. 8903 or 8903a,
if imposing the franchise fee on the plan would violate 5 U.S.C.
8909(f);

(3)
A medicare advantage plan authorized by Part C of Title XVIII of the
"Social Security Act," 42 U.S.C. 1395w-21 et seq.

(G)
(F)

"Indirect guarantee percentage" means the percentage
specified in section 1903(w)(4)(C)(ii) of the "Social Security
Act," 42 U.S.C. 1396b(w)(4)(C)(ii), that is to be used in
determining whether a health care class is indirectly held harmless
for any portion of the costs of a broad-based health-care-related
tax. If the indirect guarantee percentage changes during a fiscal
year, the indirect guarantee percentage is the following:

(1)
For the part of the fiscal year before the change takes effect, the
percentage in effect before the change;

(2)
For the part of the fiscal year beginning with the date the indirect
guarantee percentage changes, the new percentage.

(H)
"Medicaid managed care organization" has the same meaning
as in section 5167.01 of the Revised Code.

(I)
(G)

"Medicaid provider" has the same meaning as in section
5164.01 of the Revised Code.

(J)
(H)

"Ohio medicaid member month" means a month in which a
medicaid recipient residing in this state is enrolled in a health
insuring corporation plan.

(K)
(I)

"Other Ohio member month" means a month in which a resident
of this state who is not a medicaid recipient is enrolled in a health
insuring corporation plan.

(L)
(J)

"Rate year" means the fiscal year for which a franchise fee
is imposed.

Sec.
5168.76.
(A)
For the purposes specified in section 5168.85 of the Revised Code and
subject to sections 5168.82, 5168.83, and 5168.84 of the Revised
Code, a franchise fee is hereby imposed each month beginning with
July 2017 on each health insuring corporation plan. The franchise fee
shall have a component based on Ohio medicaid member months and
another component based on other Ohio member months.

(B)
The department of medicaid shall determine the amount of the monthly
franchise fee to be imposed on a health insuring corporation plan
under the component based on Ohio medicaid member months. The
determination shall be made as part of the process of determining the
annual capitated payment rates to be paid to medicaid managed care
organizations under the care management system
,
for so long as the department continues that system
.
The following rates shall be used as part of the determination:

1

2

A

CUMULATIVE
TOTAL NUMBER OF OHIO MEDICAID MEMBER MONTHS

APPLICABLE
RATE

B

For
the first 250,000

$56

C

For
250,001 to 500,000

$45

D

For
500,001 and above

$26

(C)
The amount of the monthly franchise fee to be imposed on a health
insuring corporation plan under the component based on other Ohio
member months shall be determined by multiplying the number of other
Ohio member months that the health insuring corporation plan had for
the month by the applicable rate or rates. The applicable rate or
rates to be used in the calculation for a health insuring corporation
plan for a month shall depend on the cumulative total number of other
Ohio member months the health insuring corporation plan had for all
of a rate year's months that ended before the beginning of the month
in which the franchise fee is due.

The
following table shows the applicable rate or rates:

1

2

A

CUMULATIVE
TOTAL NUMBER OF OTHER OHIO MEMBER MONTHS

APPLICABLE
RATE

B

For
the first 150,000

$2

C

For
150,001 and above

$1

Sec.
5739.01.
As
used in this chapter:

(A)
"Person" includes individuals, receivers, assignees,
trustees in bankruptcy, estates, firms, partnerships, associations,
joint-stock companies, joint ventures, clubs, societies,
corporations, the state and its political subdivisions, and
combinations of individuals of any form.

(B)
"Sale" and "selling" include all of the following
transactions for a consideration in any manner, whether absolutely or
conditionally, whether for a price or rental, in money or by
exchange, and by any means whatsoever:

(1)
All transactions by which title or possession, or both, of tangible
personal property, is or is to be transferred, or a license to use or
consume tangible personal property is or is to be granted;

(2)
All transactions by which lodging by a hotel is or is to be furnished
to transient guests;

(3)
All transactions by which:

(a)
An item of tangible personal property is or is to be repaired, except
property, the purchase of which would not be subject to the tax
imposed by section 5739.02 of the Revised Code;

(b)
An item of tangible personal property is or is to be installed,
except property, the purchase of which would not be subject to the
tax imposed by section 5739.02 of the Revised Code or property that
is or is to be incorporated into and will become a part of a
production, transmission, transportation, or distribution system for
the delivery of a public utility service;

(c)
The service of washing, cleaning, waxing, polishing, or painting a
motor vehicle is or is to be furnished;

(d)
Laundry and dry cleaning services are or are to be provided;

(e)
Automatic data processing, computer services, or electronic
information services are or are to be provided for use in business
when the true object of the transaction is the receipt by the
consumer of automatic data processing, computer services, or
electronic information services rather than the receipt of personal
or professional services to which automatic data processing, computer
services, or electronic information services are incidental or
supplemental. Notwithstanding any other provision of this chapter,
such transactions that occur between members of an affiliated group
are not sales. An "affiliated group" means two or more
persons related in such a way that one person owns or controls the
business operation of another member of the group. In the case of
corporations with stock, one corporation owns or controls another if
it owns more than fifty per cent of the other corporation's common
stock with voting rights.

(f)
Telecommunications service, including prepaid calling service,
prepaid wireless calling service, or ancillary service, is or is to
be provided, but not including coin-operated telephone service;

(g)
Landscaping and lawn care service is or is to be provided;

(h)
Private investigation and security service is or is to be provided;

(i)
Information services or tangible personal property is provided or
ordered by means of a nine hundred telephone call;

(j)
Building maintenance and janitorial service is or is to be provided;

(k)
Exterminating service is or is to be provided;

(l)
Physical fitness facility service is or is to be provided;

(m)
Recreation and sports club service is or is to be provided;

(n)
Satellite broadcasting service is or is to be provided;

(o)
Personal care service is or is to be provided to an individual. As
used in this division, "personal care service" includes
skin care, the application of cosmetics, manicuring, pedicuring, hair
removal, tattooing, body piercing, tanning, massage, and other
similar services. "Personal care service" does not include
a service provided by or on the order of a licensed physician,
certified nurse-midwife, clinical nurse specialist, certified nurse
practitioner, or chiropractor, or the cutting, coloring, or styling
of an individual's hair.

(p)
The transportation of persons by motor vehicle or aircraft is or is
to be provided, when the transportation is entirely within this
state, except for transportation provided by an ambulance service, by
a transit bus, as defined in section 5735.01 of the Revised Code, and
transportation provided by a citizen of the United States holding a
certificate of public convenience and necessity issued under 49
U.S.C. 41102;

(q)
Motor vehicle towing service is or is to be provided. As used in this
division, "motor vehicle towing service" means the towing
or conveyance of a wrecked, disabled, or illegally parked motor
vehicle.

(r)
Snow removal service is or is to be provided. As used in this
division, "snow removal service" means the removal of snow
by any mechanized means, but does not include the providing of such
service by a person that has less than five thousand dollars in sales
of such service during the calendar year.

(s)
Electronic publishing service is or is to be provided to a consumer
for use in business, except that such transactions occurring between
members of an affiliated group, as defined in division (B)(3)(e) of
this section, are not sales.

(4)
All transactions by which printed, imprinted, overprinted,
lithographic, multilithic, blueprinted, photostatic, or other
productions or reproductions of written or graphic matter are or are
to be furnished or transferred;

(5)
The production or fabrication of tangible personal property for a
consideration for consumers who furnish either directly or indirectly
the materials used in the production of fabrication work; and include
the furnishing, preparing, or serving for a consideration of any
tangible personal property consumed on the premises of the person
furnishing, preparing, or serving such tangible personal property.
Except as provided in section 5739.03 of the Revised Code, a
construction contract pursuant to which tangible personal property is
or is to be incorporated into a structure or improvement on and
becoming a part of real property is not a sale of such tangible
personal property. The construction contractor is the consumer of
such tangible personal property, provided that the sale and
installation of carpeting, the sale and installation of agricultural
land tile, the sale and erection or installation of portable grain
bins, or the provision of landscaping and lawn care service and the
transfer of property as part of such service is never a construction
contract.

As
used in division (B)(5) of this section:

(a)
"Agricultural land tile" means fired clay or concrete tile,
or flexible or rigid perforated plastic pipe or tubing, incorporated
or to be incorporated into a subsurface drainage system appurtenant
to land used or to be used primarily in production by farming,
agriculture, horticulture, or floriculture. The term does not include
such materials when they are or are to be incorporated into a
drainage system appurtenant to a building or structure even if the
building or structure is used or to be used in such production.

(b)
"Portable grain bin" means a structure that is used or to
be used by a person engaged in farming or agriculture to shelter the
person's grain and that is designed to be disassembled without
significant damage to its component parts.

(6)
All transactions in which all of the shares of stock of a closely
held corporation are transferred, or an ownership interest in a
pass-through entity, as defined in section 5733.04 of the Revised
Code, is transferred, if the corporation or pass-through entity is
not engaging in business and its entire assets consist of boats,
planes, motor vehicles, or other tangible personal property operated
primarily for the use and enjoyment of the shareholders or owners;

(7)
All transactions in which a warranty, maintenance or service
contract, or similar agreement by which the vendor of the warranty,
contract, or agreement agrees to repair or maintain the tangible
personal property of the consumer is or is to be provided;

(8)
The transfer of copyrighted motion picture films used solely for
advertising purposes, except that the transfer of such films for
exhibition purposes is not a sale;

(9)
All transactions by which tangible personal property is or is to be
stored, except such property that the consumer of the storage holds
for sale in the regular course of business;

(10)
All transactions in which "guaranteed auto protection" is
provided whereby a person promises to pay to the consumer the
difference between the amount the consumer receives from motor
vehicle insurance and the amount the consumer owes to a person
holding title to or a lien on the consumer's motor vehicle in the
event the consumer's motor vehicle suffers a total loss under the
terms of the motor vehicle insurance policy or is stolen and not
recovered, if the protection and its price are included in the
purchase or lease agreement;

(11)(a)
Except as provided in division (B)(11)(b) of this section, all
transactions by which health care services are paid for, reimbursed,
provided, delivered, arranged for, or otherwise made available by a
medicaid health insuring corporation pursuant to the corporation's
contract with the state.

(b)
If the centers for medicare and medicaid services of the United
States department of health and human services determines that the
taxation of transactions described in division (B)(11)(a) of this
section constitutes an impermissible health care-related tax under
the "Social Security Act," section 1903(w), 42 U.S.C.
1396b(w), and regulations adopted thereunder, the medicaid director
shall notify the tax commissioner of that determination. Beginning
with the first day of the month following that notification, the
transactions described in division (B)(11)(a) of this section are not
sales for the purposes of this chapter or Chapter 5741. of the
Revised Code. The tax commissioner shall order that the collection of
taxes under sections 5739.02, 5739.021, 5739.023, 5739.026, 5741.02,
5741.021, 5741.022, and 5741.023 of the Revised Code shall cease for
transactions occurring on or after that date.

(12)
All transactions by which a specified digital product is provided for
permanent use or less than permanent use, regardless of whether
continued payment is required.

(13)
All transactions by a delivery network company for the company's
delivery network services, provided the company has a waiver issued
under section 5741.072 of the Revised Code.

Except
as provided in this section, "sale" and "selling"
do not include transfers of interest in leased property where the
original lessee and the terms of the original lease agreement remain
unchanged, or professional, insurance, or personal service
transactions that involve the transfer of tangible personal property
as an inconsequential element, for which no separate charges are
made.

(C)
"Vendor" means the person providing the service or by whom
the transfer effected or license given by a sale is or is to be made
or given and, for sales described in division (B)(3)(i) of this
section, the telecommunications service vendor that provides the nine
hundred telephone service; if two or more persons are engaged in
business at the same place of business under a single trade name in
which all collections on account of sales by each are made, such
persons shall constitute a single vendor.

Physicians,
certified nurse-midwives, clinical nurse specialists, certified nurse
practitioners, dentists, hospitals, and veterinarians who are engaged
in selling tangible personal property as received from others, such
as eyeglasses, mouthwashes, dentifrices, or similar articles, are
vendors. Veterinarians who are engaged in transferring to others for
a consideration drugs, the dispensing of which does not require an
order of a licensed veterinarian, physician, certified nurse-midwife,
clinical nurse specialist, or certified nurse practitioner under
federal law, are vendors.

The
operator of any peer-to-peer car sharing program shall be considered
to be the vendor.

(D)(1)
"Consumer" means the person for whom the service is
provided, to whom the transfer effected or license given by a sale is
or is to be made or given, to whom the service described in division
(B)(3)(f) or (i) of this section is charged, or to whom the admission
is granted.

(2)
Physicians, certified nurse-midwives, clinical nurse specialists,
certified nurse practitioners, dentists, hospitals, and blood banks
operated by nonprofit institutions and persons licensed to practice
veterinary medicine, surgery, and dentistry are consumers of all
tangible personal property and services purchased by them in
connection with the practice of medicine, dentistry, the rendition of
hospital or blood bank service, or the practice of veterinary
medicine, surgery, and dentistry. In addition to being consumers of
drugs administered by them or by their assistants according to their
direction, veterinarians also are consumers of drugs that under
federal law may be dispensed only by or upon the order of a licensed
veterinarian, physician, certified nurse-midwife, clinical nurse
specialist, or certified nurse practitioner, when transferred by them
to others for a consideration to provide treatment to animals as
directed by the veterinarian.

(3)
A person who performs a facility management, or similar service
contract for a contractee is a consumer of all tangible personal
property and services purchased for use in connection with the
performance of such contract, regardless of whether title to any such
property vests in the contractee. The purchase of such property and
services is not subject to the exception for resale under division
(E) of this section.

(4)(a)
In the case of a person who purchases printed matter for the purpose
of distributing it or having it distributed to the public or to a
designated segment of the public, free of charge, that person is the
consumer of that printed matter, and the purchase of that printed
matter for that purpose is a sale.

(b)
In the case of a person who produces, rather than purchases, printed
matter for the purpose of distributing it or having it distributed to
the public or to a designated segment of the public, free of charge,
that person is the consumer of all tangible personal property and
services purchased for use or consumption in the production of that
printed matter. That person is not entitled to claim exemption under
division (B)(42)(f) of section 5739.02 of the Revised Code for any
material incorporated into the printed matter or any equipment,
supplies, or services primarily used to produce the printed matter.

(c)
The distribution of printed matter to the public or to a designated
segment of the public, free of charge, is not a sale to the members
of the public to whom the printed matter is distributed or to any
persons who purchase space in the printed matter for advertising or
other purposes.

(5)
A person who makes sales of any of the services listed in division
(B)(3) of this section is the consumer of any tangible personal
property used in performing the service. The purchase of that
property is not subject to the resale exception under division (E) of
this section.

(6)
A person who engages in highway transportation for hire is the
consumer of all packaging materials purchased by that person and used
in performing the service, except for packaging materials sold by
such person in a transaction separate from the service.

(7)
In the case of a transaction for health care services under division
(B)(11) of this section, a medicaid health insuring corporation is
the consumer of such services. The purchase of such services by a
medicaid health insuring corporation is not subject to the exception
for resale under division (E) of this section or to the exemptions
provided under divisions (B)(12), (18), (19), and (22) of section
5739.02 of the Revised Code.

(E)
"Retail sale" and "sales at retail" include all
sales, except those in which the purpose of the consumer is to resell
the thing transferred or benefit of the service provided, by a person
engaging in business, in the form in which the same is, or is to be,
received by the person.

(F)
"Business" includes any activity engaged in by any person
with the object of gain, benefit, or advantage, either direct or
indirect. "Business" does not include the activity of a
person in managing and investing the person's own funds.

(G)
"Engaging in business" means commencing, conducting, or
continuing in business, and liquidating a business when the
liquidator thereof holds itself out to the public as conducting such
business. Making a casual sale is not engaging in business.

(H)(1)(a)
"Price," except as provided in divisions (H)(2), (3), and
(4) of this section, means the total amount of consideration,
including cash, credit, property, and services, for which tangible
personal property or services are sold, leased, or rented, valued in
money, whether received in money or otherwise, without any deduction
for any of the following:

(i)
The vendor's cost of the property sold;

(ii)
The cost of materials used, labor or service costs, interest, losses,
all costs of transportation to the vendor, all taxes imposed on the
vendor, including the tax imposed under Chapter 5751. of the Revised
Code, and any other expense of the vendor;

(iii)
Charges by the vendor for any services necessary to complete the
sale;

(iv)
Delivery charges. As used in this division, "delivery charges"
means charges by the vendor for preparation and delivery to a
location designated by the consumer of tangible personal property or
a service, including transportation, shipping, postage, handling,
crating, and packing.

(v)
Installation charges;

(vi)
Credit for any trade-in.

(b)
"Price" includes consideration received by the vendor from
a third party, if the vendor actually receives the consideration from
a party other than the consumer, and the consideration is directly
related to a price reduction or discount on the sale; the vendor has
an obligation to pass the price reduction or discount through to the
consumer; the amount of the consideration attributable to the sale is
fixed and determinable by the vendor at the time of the sale of the
item to the consumer; and one of the following criteria is met:

(i)
The consumer presents a coupon, certificate, or other document to the
vendor to claim a price reduction or discount where the coupon,
certificate, or document is authorized, distributed, or granted by a
third party with the understanding that the third party will
reimburse any vendor to whom the coupon, certificate, or document is
presented;

(ii)
The consumer identifies the consumer's self to the seller as a member
of a group or organization entitled to a price reduction or discount.
A preferred customer card that is available to any patron does not
constitute membership in such a group or organization.

(iii)
The price reduction or discount is identified as a third party price
reduction or discount on the invoice received by the consumer, or on
a coupon, certificate, or other document presented by the consumer.

(c)
"Price" does not include any of the following:

(i)
Discounts, including cash, term, or coupons that are not reimbursed
by a third party that are allowed by a vendor and taken by a consumer
on a sale;

(ii)
Interest, financing, and carrying charges from credit extended on the
sale of tangible personal property or services, if the amount is
separately stated on the invoice, bill of sale, or similar document
given to the purchaser;

(iii)
Any taxes legally imposed directly on the consumer that are
separately stated on the invoice, bill of sale, or similar document
given to the consumer. For the purpose of this division, the tax
imposed under Chapter 5751. of the Revised Code is not a tax directly
on the consumer, even if the tax or a portion thereof is separately
stated.

(iv)
Notwithstanding divisions (H)(1)(b)(i) to (iii) of this section, any
discount allowed by an automobile manufacturer to its employee, or to
the employee of a supplier, on the purchase of a new motor vehicle
from a new motor vehicle dealer in this state.

(v)
The dollar value of a gift card that is not sold by a vendor or
purchased by a consumer and that is redeemed by the consumer in
purchasing tangible personal property or services if the vendor is
not reimbursed and does not receive compensation from a third party
to cover all or part of the gift card value. For the purposes of this
division, a gift card is not sold by a vendor or purchased by a
consumer if it is distributed pursuant to an awards, loyalty, or
promotional program. Past and present purchases of tangible personal
property or services by the consumer shall not be treated as
consideration exchanged for a gift card.

(2)
In the case of a sale of any new motor vehicle by a new motor vehicle
dealer, as defined in section 4517.01 of the Revised Code, in which
another motor vehicle is accepted by the dealer as part of the
consideration received, "price" has the same meaning as in
division (H)(1) of this section, reduced by the credit afforded the
consumer by the dealer for the motor vehicle received in trade.

(3)
In the case of a sale of any watercraft or outboard motor by a
watercraft dealer licensed in accordance with section 1547.543 of the
Revised Code, in which another watercraft, watercraft and trailer, or
outboard motor is accepted by the dealer as part of the consideration
received, "price" has the same meaning as in division
(H)(1) of this section, reduced by the credit afforded the consumer
by the dealer for the watercraft, watercraft and trailer, or outboard
motor received in trade. As used in this division, "watercraft"
includes an outdrive unit attached to the watercraft.

(4)
In the case of transactions for health care services under division
(B)(11) of this section, "price" means the amount of
managed care premiums received each month by a medicaid health
insuring corporation.

(I)
"Receipts" means the total amount of the prices of the
sales of vendors, provided that the dollar value of gift cards
distributed pursuant to an awards, loyalty, or promotional program,
and cash discounts allowed and taken on sales at the time they are
consummated are not included, minus any amount deducted as a bad debt
pursuant to section 5739.121 of the Revised Code. "Receipts"
does not include the sale price of property returned or services
rejected by consumers when the full sale price and tax are refunded
either in cash or by credit.

(J)
"Place of business" means any location at which a person
engages in business.

(K)
"Premises" includes any real property or portion thereof
upon which any person engages in selling tangible personal property
at retail or making retail sales and also includes any real property
or portion thereof designated for, or devoted to, use in conjunction
with the business engaged in by such person.

(L)
"Casual sale" means a sale of an item of tangible personal
property, in person or online, that was obtained by the person making
the sale, through purchase or otherwise, for the person's own use and
was previously subject to any state's taxing jurisdiction on its sale
or use, and includes such items acquired for the seller's use that
are sold by an auctioneer employed directly by the person for such
purpose, provided the location of such sales is not the auctioneer's
physical permanent place of business. As used in this division,
"permanent place of business" includes any physical
location where such auctioneer has conducted more than two auctions
during the year.

(M)
"Hotel" means every establishment kept, used, maintained,
advertised, or held out to the public to be a place where sleeping
accommodations are offered to guests, in which five or more rooms are
used for the accommodation of such guests, whether the rooms are in
one or several structures, except as otherwise provided in section
5739.091 of the Revised Code.

(N)
"Transient guests" means persons occupying a room or rooms
for sleeping accommodations for less than thirty consecutive days.

(O)
"Making retail sales" means the effecting of transactions
wherein one party is obligated to pay the price and the other party
is obligated to provide a service or to transfer title to or
possession of the item sold. "Making retail sales" does not
include the preliminary acts of promoting or soliciting the retail
sales, other than the distribution of printed matter which displays
or describes and prices the item offered for sale, nor does it
include delivery of a predetermined quantity of tangible personal
property or transportation of property or personnel to or from a
place where a service is performed.

(P)
"Used directly in the rendition of a public utility service"
means that property that is to be incorporated into and will become a
part of the consumer's production, transmission, transportation, or
distribution system and that retains its classification as tangible
personal property after such incorporation; fuel or power used in the
production, transmission, transportation, or distribution system; and
tangible personal property used in the repair and maintenance of the
production, transmission, transportation, or distribution system,
including only such motor vehicles as are specially designed and
equipped for such use. Tangible personal property and services used
primarily in providing highway transportation for hire are not used
directly in the rendition of a public utility service. In this
definition, "public utility" includes a citizen of the
United States holding, and required to hold, a certificate of public
convenience and necessity issued under 49 U.S.C. 41102.

(Q)
"Refining" means removing or separating a desirable product
from raw or contaminated materials by distillation or physical,
mechanical, or chemical processes.

(R)
"Assembly" and "assembling" mean attaching or
fitting together parts to form a product, but do not include
packaging a product.

(S)
"Manufacturing operation" means a process in which
materials are changed, converted, or transformed into a different
state or form from which they previously existed and includes
refining materials, assembling parts, and preparing raw materials and
parts by mixing, measuring, blending, or otherwise committing such
materials or parts to the manufacturing process. "Manufacturing
operation" does not include packaging.

(T)
"Fiscal officer" means, with respect to a regional transit
authority, the secretary-treasurer thereof, and with respect to a
county that is a transit authority, the fiscal officer of the county
transit board if one is appointed pursuant to section 306.03 of the
Revised Code or the county auditor if the board of county
commissioners operates the county transit system.

(U)
"Transit authority" means a regional transit authority
created pursuant to section 306.31 of the Revised Code or a county in
which a county transit system is created pursuant to section 306.01
of the Revised Code. For the purposes of this chapter, a transit
authority must extend to at least the entire area of a single county.
A transit authority that includes territory in more than one county
must include all the area of the most populous county that is a part
of such transit authority. County population shall be measured by the
most recent census taken by the United States census bureau.

(V)
"Legislative authority" means, with respect to a regional
transit authority, the board of trustees thereof, and with respect to
a county that is a transit authority, the board of county
commissioners.

(W)
"Territory of the transit authority" means all of the area
included within the territorial boundaries of a transit authority as
they from time to time exist. Such territorial boundaries must at all
times include all the area of a single county or all the area of the
most populous county that is a part of such transit authority. County
population shall be measured by the most recent census taken by the
United States census bureau.

(X)
"Providing a service" means providing or furnishing
anything described in division (B)(3) of this section for
consideration.

(Y)(1)(a)
"Automatic data processing" means processing of others'
data, including keypunching or similar data entry services together
with verification thereof, or providing access to computer equipment
for the purpose of processing data.

(b)
"Computer services" means providing services consisting of
specifying computer hardware configurations and evaluating technical
processing characteristics, computer programming, and training of
computer programmers and operators, provided in conjunction with and
to support the sale, lease, or operation of taxable computer
equipment or systems.

(c)
"Electronic information services" means providing access to
computer equipment by means of telecommunications equipment for the
purpose of either of the following:

(i)
Examining or acquiring data stored in or accessible to the computer
equipment;

(ii)
Placing data into the computer equipment to be retrieved by
designated recipients with access to the computer equipment.

"Electronic
information services" does not include electronic publishing.

(d)
"Automatic data processing, computer services, or electronic
information services" shall not include personal or professional
services.

(2)
As used in divisions (B)(3)(e) and (Y)(1) of this section, "personal
and professional services" means all services other than
automatic data processing, computer services, or electronic
information services, including but not limited to:

(a)
Accounting and legal services such as advice on tax matters, asset
management, budgetary matters, quality control, information security,
and auditing and any other situation where the service provider
receives data or information and studies, alters, analyzes,
interprets, or adjusts such material;

(b)
Analyzing business policies and procedures;

(c)
Identifying management information needs;

(d)
Feasibility studies, including economic and technical analysis of
existing or potential computer hardware or software needs and
alternatives;

(e)
Designing policies, procedures, and custom software for collecting
business information, and determining how data should be summarized,
sequenced, formatted, processed, controlled, and reported so that it
will be meaningful to management;

(f)
Developing policies and procedures that document how business events
and transactions are to be authorized, executed, and controlled;

(g)
Testing of business procedures;

(h)
Training personnel in business procedure applications;

(i)
Providing credit information to users of such information by a
consumer reporting agency, as defined in the "Fair Credit
Reporting Act," 84 Stat. 1114, 1129 (1970), 15 U.S.C. 1681a(f),
or as hereafter amended, including but not limited to gathering,
organizing, analyzing, recording, and furnishing such information by
any oral, written, graphic, or electronic medium;

(j)
Providing debt collection services by any oral, written, graphic, or
electronic means;

(k)
Providing digital advertising services;

(l)
Providing services to electronically file any federal, state, or
local individual income tax return, report, or other related document
or schedule with a federal, state, or local government entity or to
electronically remit a payment of any such individual income tax to
such an entity. For the purpose of this division, "individual
income tax" does not include federal, state, or local taxes
withheld by an employer from an employee's compensation.

The
services listed in divisions (Y)(2)(a) to (l) of this section are not
automatic data processing or computer services.

(Z)
"Highway transportation for hire" means the transportation
of personal property belonging to others for consideration by any of
the following:

(1)
The holder of a permit or certificate issued by this state or the
United States authorizing the holder to engage in transportation of
personal property belonging to others for consideration over or on
highways, roadways, streets, or any similar public thoroughfare;

(2)
A person who engages in the transportation of personal property
belonging to others for consideration over or on highways, roadways,
streets, or any similar public thoroughfare but who could not have
engaged in such transportation on December 11, 1985, unless the
person was the holder of a permit or certificate of the types
described in division (Z)(1) of this section;

(3)
A person who leases a motor vehicle to and operates it for a person
described by division (Z)(1) or (2) of this section.

"Highway
transportation for hire" does not include delivery network
services.

(AA)(1)
"Telecommunications service" means the electronic
transmission, conveyance, or routing of voice, data, audio, video, or
any other information or signals to a point, or between or among
points. "Telecommunications service" includes such
transmission, conveyance, or routing in which computer processing
applications are used to act on the form, code, or protocol of the
content for purposes of transmission, conveyance, or routing without
regard to whether the service is referred to as voice-over internet
protocol service or is classified by the federal communications
commission as enhanced or value-added. "Telecommunications
service" does not include any of the following:

(a)
Data processing and information services that allow data to be
generated, acquired, stored, processed, or retrieved and delivered by
an electronic transmission to a consumer where the consumer's primary
purpose for the underlying transaction is the processed data or
information;

(b)
Installation or maintenance of wiring or equipment on a customer's
premises;

(c)
Tangible personal property;

(d)
Advertising, including directory advertising;

(e)
Billing and collection services provided to third parties;

(f)
Internet access service;

(g)
Radio and television audio and video programming services, regardless
of the medium, including the furnishing of transmission, conveyance,
and routing of such services by the programming service provider.
Radio and television audio and video programming services include,
but are not limited to, cable service, as defined in 47 U.S.C.
522(6), and audio and video programming services delivered by
commercial mobile radio service providers, as defined in 47 C.F.R.
20.3;

(h)
Ancillary service;

(i)
Digital products delivered electronically, including software, music,
video, reading materials, or ring tones.

(2)
"Ancillary service" means a service that is associated with
or incidental to the provision of telecommunications service,
including conference bridging service, detailed telecommunications
billing service, directory assistance, vertical service, and voice
mail service. As used in this division:

(a)
"Conference bridging service" means an ancillary service
that links two or more participants of an audio or video conference
call, including providing a telephone number. "Conference
bridging service" does not include telecommunications services
used to reach the conference bridge.

(b)
"Detailed telecommunications billing service" means an
ancillary service of separately stating information pertaining to
individual calls on a customer's billing statement.

(c)
"Directory assistance" means an ancillary service of
providing telephone number or address information.

(d)
"Vertical service" means an ancillary service that is
offered in connection with one or more telecommunications services,
which offers advanced calling features that allow customers to
identify callers and manage multiple calls and call connections,
including conference bridging service.

(e)
"Voice mail service" means an ancillary service that
enables the customer to store, send, or receive recorded messages.
"Voice mail service" does not include any vertical services
that the customer may be required to have in order to utilize the
voice mail service.

(3)
"900 service" means an inbound toll telecommunications
service purchased by a subscriber that allows the subscriber's
customers to call in to the subscriber's prerecorded announcement or
live service, and which is typically marketed under the name "900
service" and any subsequent numbers designated by the federal
communications commission. "900 service" does not include
the charge for collection services provided by the seller of the
telecommunications service to the subscriber, or services or products
sold by the subscriber to the subscriber's customer.

(4)
"Prepaid calling service" means the right to access
exclusively telecommunications services, which must be paid for in
advance and which enables the origination of calls using an access
number or authorization code, whether manually or electronically
dialed, and that is sold in predetermined units or dollars of which
the number declines with use in a known amount.

(5)
"Prepaid wireless calling service" means a
telecommunications service that provides the right to utilize mobile
telecommunications service as well as other non-telecommunications
services, including the download of digital products delivered
electronically, and content and ancillary services, that must be paid
for in advance and that is sold in predetermined units or dollars of
which the number declines with use in a known amount.

(6)
"Value-added non-voice data service" means a
telecommunications service in which computer processing applications
are used to act on the form, content, code, or protocol of the
information or data primarily for a purpose other than transmission,
conveyance, or routing.

(7)
"Coin-operated telephone service" means a
telecommunications service paid for by inserting money into a
telephone accepting direct deposits of money to operate.

(8)
"Customer" has the same meaning as in section 5739.034 of
the Revised Code.

(BB)
"Laundry and dry cleaning services" means removing soil or
dirt from towels, linens, articles of clothing, or other fabric items
that belong to others and supplying towels, linens, articles of
clothing, or other fabric items. "Laundry and dry cleaning
services" does not include the provision of self-service
facilities for use by consumers to remove soil or dirt from towels,
linens, articles of clothing, or other fabric items.

(CC)
"Magazines distributed as controlled circulation publications"
means magazines containing at least twenty-four pages, at least
twenty-five per cent editorial content, issued at regular intervals
four or more times a year, and circulated without charge to the
recipient, provided that such magazines are not owned or controlled
by individuals or business concerns which conduct such publications
as an auxiliary to, and essentially for the advancement of the main
business or calling of, those who own or control them.

(DD)
"Landscaping and lawn care service" means the services of
planting, seeding, sodding, removing, cutting, trimming, pruning,
mulching, aerating, applying chemicals, watering, fertilizing, and
providing similar services to establish, promote, or control the
growth of trees, shrubs, flowers, grass, ground cover, and other
flora, or otherwise maintaining a lawn or landscape grown or
maintained by the owner for ornamentation or other nonagricultural
purpose. However, "landscaping and lawn care service" does
not include the providing of such services by a person who has less
than five thousand dollars in sales of such services during the
calendar year.

(EE)
"Private investigation and security service" means the
performance of any activity for which the provider of such service is
required to be licensed pursuant to Chapter 4749. of the Revised
Code, or would be required to be so licensed in performing such
services in this state, and also includes the services of conducting
polygraph examinations and of monitoring or overseeing the activities
on or in, or the condition of, the consumer's home, business, or
other facility by means of electronic or similar monitoring devices.
"Private investigation and security service" does not
include special duty services provided by off-duty police officers,
deputy sheriffs, and other peace officers regularly employed by the
state or a political subdivision.

(FF)
"Information services" means providing conversation, giving
consultation or advice, playing or making a voice or other recording,
making or keeping a record of the number of callers, and any other
service provided to a consumer by means of a nine hundred telephone
call, except when the nine hundred telephone call is the means by
which the consumer makes a contribution to a recognized charity.

(GG)
"Research and development" means designing, creating, or
formulating new or enhanced products, equipment, or manufacturing
processes, and also means conducting scientific or technological
inquiry and experimentation in the physical sciences with the goal of
increasing scientific knowledge which may reveal the bases for new or
enhanced products, equipment, or manufacturing processes.

(HH)
"Qualified research and development equipment" means either
of the following:

(1)
Capitalized tangible personal property, and leased personal property
that would be capitalized if purchased, used by a person primarily to
perform research and development;

(2)
Any tangible personal property used by a megaproject operator
primarily to perform research and development at the site of a
megaproject that satisfies the criteria described in division
(A)(11)(a)(ii) of section 122.17 of the Revised Code during the
period that the megaproject operator has an agreement for such
megaproject with the tax credit authority under division (D) of that
section that remains in effect and has not expired or been
terminated.

"Qualified
research and development equipment" does not include tangible
personal property primarily used in testing, as defined in division
(A)(4) of section 5739.011 of the Revised Code, or used for recording
or storing test results, unless such property is primarily used by
the consumer in testing the product, equipment, or manufacturing
process being created, designed, or formulated by the consumer in the
research and development activity or in recording or storing such
test results.

(II)
"Building maintenance and janitorial service" means
cleaning the interior or exterior of a building and any tangible
personal property located therein or thereon, including any services
incidental to such cleaning for which no separate charge is made.
However, "building maintenance and janitorial service" does
not include the providing of such service by a person who has less
than five thousand dollars in sales of such service during the
calendar year. As used in this division, "cleaning" does
not include sanitation services necessary for an establishment
described in 21 U.S.C. 608 to comply with rules and regulations
adopted pursuant to that section.

(JJ)
"Exterminating service" means eradicating or attempting to
eradicate vermin infestations from a building or structure, or the
area surrounding a building or structure, and includes activities to
inspect, detect, or prevent vermin infestation of a building or
structure.

(KK)
"Physical fitness facility service" means all transactions
by which a membership is granted, maintained, or renewed, including
initiation fees, membership dues, renewal fees, monthly minimum fees,
and other similar fees and dues, by a physical fitness facility such
as an athletic club, health spa, or gymnasium, which entitles the
member to use the facility for physical exercise.

(LL)
"Recreation and sports club service" means all transactions
by which a membership is granted, maintained, or renewed, including
initiation fees, membership dues, renewal fees, monthly minimum fees,
and other similar fees and dues, by a recreation and sports club,
which entitles the member to use the facilities of the organization.
"Recreation and sports club" means an organization that has
ownership of, or controls or leases on a continuing, long-term basis,
the facilities used by its members and includes an aviation club, gun
or shooting club, yacht club, card club, swimming club, tennis club,
golf club, country club, riding club, amateur sports club, or similar
organization.

(MM)
"Livestock" means farm animals commonly raised for food,
food production, or other agricultural purposes, including, but not
limited to, cattle, sheep, goats, swine, poultry, and captive deer.
"Livestock" does not include invertebrates, amphibians,
reptiles, domestic pets, animals for use in laboratories or for
exhibition, or other animals not commonly raised for food or food
production.

(NN)
"Livestock structure" means a building or structure used
exclusively for the housing, raising, feeding, or sheltering of
livestock, and includes feed storage or handling structures and
structures for livestock waste handling.

(OO)
"Horticulture" means the growing, cultivation, and
production of flowers, fruits, herbs, vegetables, sod, mushrooms, and
nursery stock. As used in this division, "nursery stock"
has the same meaning as in section 927.51 of the Revised Code.

(PP)
"Horticulture structure" means a building or structure used
exclusively for the commercial growing, raising, or overwintering of
horticultural products, and includes the area used for stocking,
storing, and packing horticultural products when done in conjunction
with the production of those products.

(QQ)
"Newspaper" means an unbound publication bearing a title or
name that is regularly published, at least as frequently as biweekly,
and distributed from a fixed place of business to the public in a
specific geographic area, and that contains a substantial amount of
news matter of international, national, or local events of interest
to the general public.

(RR)(1)
"Feminine hygiene products" means tampons, panty liners,
menstrual cups, sanitary napkins, and other similar tangible personal
property designed for feminine hygiene in connection with the human
menstrual cycle, but does not include grooming and hygiene products.

(2)
"Grooming and hygiene products" means soaps and cleaning
solutions, shampoo, toothpaste, mouthwash, antiperspirants, and sun
tan lotions and screens, regardless of whether any of these products
are over-the-counter drugs.

(3)
"Over-the-counter drugs" means a drug that contains a label
that identifies the product as a drug as required by 21 C.F.R.
201.66, which label includes a drug facts panel or a statement of the
active ingredients with a list of those ingredients contained in the
compound, substance, or preparation.

(SS)(1)
"Lease" or "rental" means any transfer of the
possession or control of tangible personal property for a fixed or
indefinite term, for consideration. "Lease" or "rental"
includes future options to purchase or extend, and agreements
described in 26 U.S.C. 7701(h)(1) covering motor vehicles and
trailers where the amount of consideration may be increased or
decreased by reference to the amount realized upon the sale or
disposition of the property. "Lease" or "rental"
does not include:

(a)
A transfer of possession or control of tangible personal property
under a security agreement or a deferred payment plan that requires
the transfer of title upon completion of the required payments;

(b)
A transfer of possession or control of tangible personal property
under an agreement that requires the transfer of title upon
completion of required payments and payment of an option price that
does not exceed the greater of one hundred dollars or one per cent of
the total required payments;

(c)
Providing tangible personal property along with an operator for a
fixed or indefinite period of time, if the operator is necessary for
the property to perform as designed. For purposes of this division,
the operator must do more than maintain, inspect, or set up the
tangible personal property.

(2)
"Lease" and "rental," as defined in division (SS)
of this section, shall not apply to leases or rentals that exist
before June 26, 2003.

(3)
"Lease" and "rental" have the same meaning as in
division (SS)(1) of this section regardless of whether a transaction
is characterized as a lease or rental under generally accepted
accounting principles, the Internal Revenue Code, Title XIII of the
Revised Code, or other federal, state, or local laws.

(TT)
"Mobile telecommunications service" has the same meaning as
in the "Mobile Telecommunications Sourcing Act," Pub. L.
No. 106-252, 114 Stat. 631 (2000), 4 U.S.C.A. 124(7), as amended,
and, on and after August 1, 2003, includes related fees and ancillary
services, including universal service fees, detailed billing service,
directory assistance, service initiation, voice mail service, and
vertical services, such as caller ID and three-way calling.

(UU)
"Certified service provider" has the same meaning as in
section 5740.01 of the Revised Code.

(VV)
"Satellite broadcasting service" means the distribution or
broadcasting of programming or services by satellite directly to the
subscriber's receiving equipment without the use of ground receiving
or distribution equipment, except the subscriber's receiving
equipment or equipment used in the uplink process to the satellite,
and includes all service and rental charges, premium channels or
other special services, installation and repair service charges, and
any other charges having any connection with the provision of the
satellite broadcasting service.

(WW)
"Tangible personal property" means personal property that
can be seen, weighed, measured, felt, or touched, or that is in any
other manner perceptible to the senses. For purposes of this chapter
and Chapter 5741. of the Revised Code, "tangible personal
property" includes motor vehicles, electricity, water, gas,
steam, and prewritten computer software.

(XX)
"Municipal gas utility" means a municipal corporation that
owns or operates a system for the distribution of natural gas.

(YY)
"Computer" means an electronic device that accepts
information in digital or similar form and manipulates it for a
result based on a sequence of instructions.

(ZZ)
"Computer software" means a set of coded instructions
designed to cause a computer or automatic data processing equipment
to perform a task.

(AAA)
"Delivered electronically" means delivery of computer
software from the seller to the purchaser by means other than
tangible storage media.

(BBB)
"Prewritten computer software" means computer software,
including prewritten upgrades, that is not designed and developed by
the author or other creator to the specifications of a specific
purchaser. The combining of two or more prewritten computer software
programs or prewritten portions thereof does not cause the
combination to be other than prewritten computer software.
"Prewritten computer software" includes software designed
and developed by the author or other creator to the specifications of
a specific purchaser when it is sold to a person other than the
purchaser. If a person modifies or enhances computer software of
which the person is not the author or creator, the person shall be
deemed to be the author or creator only of such person's
modifications or enhancements. Prewritten computer software or a
prewritten portion thereof that is modified or enhanced to any
degree, where such modification or enhancement is designed and
developed to the specifications of a specific purchaser, remains
prewritten computer software; provided, however, that where there is
a reasonable, separately stated charge or an invoice or other
statement of the price given to the purchaser for the modification or
enhancement, the modification or enhancement shall not constitute
prewritten computer software.

(CCC)(1)
"Food" means substances, whether in liquid, concentrated,
solid, frozen, dried, or dehydrated form, that are sold for ingestion
or chewing by humans and are consumed for their taste or nutritional
value. "Food" does not include alcoholic beverages, dietary
supplements, soft drinks, or tobacco.

(2)
As used in division (CCC)(1) of this section:

(a)
"Dietary supplements" means any product, other than
tobacco, that is intended to supplement the diet and that is intended
for ingestion in tablet, capsule, powder, softgel, gelcap, or liquid
form, or, if not intended for ingestion in such a form, is not
represented as conventional food for use as a sole item of a meal or
of the diet; that is required to be labeled as a dietary supplement,
identifiable by the "supplement facts" box found on the
label, as required by 21 C.F.R. 101.36; and that contains one or more
of the following dietary ingredients:

(i)
A vitamin;

(ii)
A mineral;

(iii)
An herb or other botanical;

(iv)
An amino acid;

(v)
A dietary substance for use by humans to supplement the diet by
increasing the total dietary intake;

(vi)
A concentrate, metabolite, constituent, extract, or combination of
any ingredient described in divisions (CCC)(2)(a)(i) to (v) of this
section.

(b)
"Soft drinks" means nonalcoholic beverages that contain
natural or artificial sweeteners. "Soft drinks" does not
include beverages that contain milk or milk products, soy, rice, or
similar milk substitutes, or that contains greater than fifty per
cent vegetable or fruit juice by volume.

(DDD)
"Drug" means a compound, substance, or preparation, and any
component of a compound, substance, or preparation, other than food,
dietary supplements, or alcoholic beverages that is recognized in the
official United States pharmacopoeia, official homeopathic
pharmacopoeia of the United States, or official national formulary,
and supplements to them; is intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease; or is intended to
affect the structure or any function of the body.

(EEE)
"Prescription" means an order, formula, or recipe issued in
any form of oral, written, electronic, or other means of transmission
by a duly licensed practitioner authorized by the laws of this state
to issue a prescription.

(FFF)
"Durable medical equipment" means equipment, including
repair and replacement parts for such equipment, that can withstand
repeated use, is primarily and customarily used to serve a medical
purpose, generally is not useful to a person in the absence of
illness or injury, and is not worn in or on the body. "Durable
medical equipment" does not include mobility enhancing
equipment.

(GGG)
"Mobility enhancing equipment" means equipment, including
repair and replacement parts for such equipment, that is primarily
and customarily used to provide or increase the ability to move from
one place to another and is appropriate for use either in a home or a
motor vehicle, that is not generally used by persons with normal
mobility, and that does not include any motor vehicle or equipment on
a motor vehicle normally provided by a motor vehicle manufacturer.
"Mobility enhancing equipment" does not include durable
medical equipment.

(HHH)
"Prosthetic device" means a replacement, corrective, or
supportive device, including repair and replacement parts for the
device, worn on or in the human body to artificially replace a
missing portion of the body, prevent or correct physical deformity or
malfunction, or support a weak or deformed portion of the body. As
used in this division, before July 1, 2019, "prosthetic device"
does not include corrective eyeglasses, contact lenses, or dental
prosthesis. On or after July 1, 2019, "prosthetic device"
does not include dental prosthesis but does include corrective
eyeglasses or contact lenses.

(III)(1)
"Fractional aircraft ownership program" means a program in
which persons within an affiliated group sell and manage fractional
ownership program aircraft, provided that at least one hundred
airworthy aircraft are operated in the program and the program meets
all of the following criteria:

(a)
Management services are provided by at least one program manager
within an affiliated group on behalf of the fractional owners.

(b)
Each program aircraft is owned or possessed by at least one
fractional owner.

(c)
Each fractional owner owns or possesses at least a one-sixteenth
interest in at least one fixed-wing program aircraft.

(d)
A dry-lease aircraft interchange arrangement is in effect among all
of the fractional owners.

(e)
Multi-year program agreements are in effect regarding the fractional
ownership, management services, and dry-lease aircraft interchange
arrangement aspects of the program.

(2)
As used in division (III)(1) of this section:

(a)
"Affiliated group" has the same meaning as in division
(B)(3)(e) of this section.

(b)
"Fractional owner" means a person that owns or possesses at
least a one-sixteenth interest in a program aircraft and has entered
into the agreements described in division (III)(1)(e) of this
section.

(c)
"Fractional ownership program aircraft" or "program
aircraft" means a turbojet aircraft that is owned or possessed
by a fractional owner and that has been included in a dry-lease
aircraft interchange arrangement and agreement under divisions
(III)(1)(d) and (e) of this section, or an aircraft a program manager
owns or possesses primarily for use in a fractional aircraft
ownership program.

(d)
"Management services" means administrative and aviation
support services furnished under a fractional aircraft ownership
program in accordance with a management services agreement under
division (III)(1)(e) of this section, and offered by the program
manager to the fractional owners, including, at a minimum, the
establishment and implementation of safety guidelines; the
coordination of the scheduling of the program aircraft and crews;
program aircraft maintenance; program aircraft insurance; crew
training for crews employed, furnished, or contracted by the program
manager or the fractional owner; the satisfaction of record-keeping
requirements; and the development and use of an operations manual and
a maintenance manual for the fractional aircraft ownership program.

(e)
"Program manager" means the person that offers management
services to fractional owners pursuant to a management services
agreement under division (III)(1)(e) of this section.

(JJJ)
"Electronic publishing" means providing access to one or
more of the following primarily for business customers, including the
federal government or a state government or a political subdivision
thereof, to conduct research: news; business, financial, legal,
consumer, or credit materials; editorials, columns, reader
commentary, or features; photos or images; archival or research
material; legal notices, identity verification, or public records;
scientific, educational, instructional, technical, professional,
trade, or other literary materials; or other similar information
which has been gathered and made available by the provider to the
consumer in an electronic format. Providing electronic publishing
includes the functions necessary for the acquisition, formatting,
editing, storage, and dissemination of data or information that is
the subject of a sale.

(KKK)

"Medicaid
health insuring corporation" means a health insuring corporation
that holds a certificate of authority under Chapter 1751. of the
Revised Code and is under contract with the department of medicaid
pursuant to section 5167.10 of the Revised Code.

(LLL)

"Managed
care premium" means any premium, capitation, or other payment a
medicaid health insuring corporation receives for providing or
arranging for the provision of health care services to its members or
enrollees residing in this state.

(MMM)
(LLL)

"Captive deer" means deer and other cervidae that have been
legally acquired, or their offspring, that are privately owned for
agricultural or farming purposes.

(NNN)
(MMM)

"Gift card" means a document, card, certificate, or other
record, whether tangible or intangible, that may be redeemed by a
consumer for a dollar value when making a purchase of tangible
personal property or services.

(OOO)
(NNN)

"Specified digital product" means an electronically
transferred digital audiovisual work, digital audio work, or digital
book.

As
used in division
(OOO)
(NNN)

of this section:

(1)
"Digital audiovisual work" means a series of related images
that, when shown in succession, impart an impression of motion,
together with accompanying sounds, if any.

(2)
"Digital audio work" means a work that results from the
fixation of a series of musical, spoken, or other sounds, including
digitized sound files that are downloaded onto a device and that may
be used to alert the customer with respect to a communication.

(3)
"Digital book" means a work that is generally recognized in
the ordinary and usual sense as a book.

(4)
"Electronically transferred" means obtained by the
purchaser by means other than tangible storage media.

(PPP)
(OOO)

"Digital advertising services" means providing access, by
means of telecommunications equipment, to computer equipment that is
used to enter, upload, download, review, manipulate, store, add, or
delete data for the purpose of electronically displaying, delivering,
placing, or transferring promotional advertisements to potential
customers about products or services or about industry or business
brands.

(QQQ)
(PPP)

"Peer-to-peer car sharing program" has the same meaning as
in section 4516.01 of the Revised Code.

(RRR)
(QQQ)

"Megaproject" and "megaproject operator" have the
same meanings as in section 122.17 of the Revised Code.

(SSS)(1)
(RRR)(1)

"Diaper" means an absorbent garment worn by humans who are
incapable of, or have difficulty, controlling their bladder or bowel
movements.

(2)
"Children's diaper" means a diaper marketed to be worn by
children.

(3)
"Adult diaper" means a diaper other than a children's
diaper.

(TTT)
(SSS)

"Sales tax holiday" means three or more dates on which
sales of all eligible tangible personal property are exempt from the
taxes levied under sections 5739.02, 5739.021, 5739.023, 5739.026,
5741.02, 5741.021, 5741.022, and 5741.023 of the Revised Code.

(UUU)
(TTT)

"Eligible tangible personal property" means any item of
tangible personal property that meets both of the following
requirements:

(1)
The price of the item does not exceed five hundred dollars;

(2)
The item is not a watercraft or outboard motor required to be titled
pursuant to Chapter 1548. of the Revised Code, a motor vehicle, an
alcoholic beverage, tobacco, a vapor product as defined in section
5743.01 of the Revised Code, or an item that contains marijuana as
defined in section 3796.01 of the Revised Code.

(VVV)
(UUU)

"Alcoholic beverages" means beverages that are suitable for
human consumption and contain one-half of one per cent or more of
alcohol by volume.

(WWW)
(VVV)

"Tobacco" means cigarettes, cigars, chewing or pipe
tobacco, or any other item that contains tobacco.

(XXX)(1)
(WWW)(1)

"Delivery network company" means a person that operates a
business platform, including a web site or mobile application, to
facilitate delivery network services.

(2)
"Delivery network courier" means an individual connected to
a consumer through a delivery network company and who provides
delivery network services to that consumer.

(3)
"Delivery network services" means both of the following
when performed as part of a single transaction:

(a)
Pickup of a local product by a delivery network courier from a local
merchant that is not under common ownership or control of the
delivery network company through which the transaction was initiated,
and which may include selection, collection, and purchase of the
local product;

(b)
Delivery by the delivery network courier of that local product to a
location designated by the consumer that is not more than
seventy-five miles from the local merchant's place of business where
the pickup described in division (XXX)(3)(a) of this section occurs.

(4)
"Local merchant" means a person engaged in selling local
products from a temporary or fixed place of business in this state,
including a kitchen, restaurant, grocery store, retail store, or
convenience store.

(5)
"Local product" means any tangible personal property,
including food, but excluding freight, mail, or a package to which
postage is affixed.

Sec.
5739.03.
(A)
Except as provided in section 5739.05
or
section 5739.051
of
the Revised Code, the tax imposed by or pursuant to section 5739.02,
5739.021, 5739.023, or 5739.026 of the Revised Code shall be paid by
the consumer to the vendor, and each vendor shall collect from the
consumer, as a trustee for the state of Ohio, the full and exact
amount of the tax payable on each taxable sale, in the manner and at
the times provided as follows:

(1)
If the price is, at or prior to the provision of the service or the
delivery of possession of the thing sold to the consumer, paid in
currency passed from hand to hand by the consumer or the consumer's
agent to the vendor or the vendor's agent, the vendor or the vendor's
agent shall collect the tax with and at the same time as the price;

(2)
If the price is otherwise paid or to be paid, the vendor or the
vendor's agent shall, at or prior to the provision of the service or
the delivery of possession of the thing sold to the consumer, charge
the tax imposed by or pursuant to section 5739.02, 5739.021,
5739.023, or 5739.026 of the Revised Code to the account of the
consumer, which amount shall be collected by the vendor from the
consumer in addition to the price. Such sale shall be reported on and
the amount of the tax applicable thereto shall be remitted with the
return for the period in which the sale is made, and the amount of
the tax shall become a legal charge in favor of the vendor and
against the consumer.

(B)(1)(a)
If any sale is claimed to be exempt under division (E) of section
5739.01 of the Revised Code or under section 5739.02 of the Revised
Code, with the exception of divisions (B)(1) to (11), (28), (48),
(55), (59), or (62) of section 5739.02 of the Revised Code, the
consumer must provide to the vendor, and the vendor must obtain from
the consumer, a certificate specifying the reason that the sale is
not legally subject to the tax. The certificate shall be in such
form, and shall be provided either in a hard copy form or electronic
form, as the tax commissioner prescribes.

(b)
A vendor that obtains a fully completed exemption certificate from a
consumer is relieved of liability for collecting and remitting tax on
any sale covered by that certificate. If it is determined the
exemption was improperly claimed, the consumer shall be liable for
any tax due on that sale under section 5739.02, 5739.021, 5739.023,
or 5739.026 or Chapter 5741. of the Revised Code. Relief under this
division from liability does not apply to any of the following:

(i)
A vendor that fraudulently fails to collect tax;

(ii)
A vendor that solicits consumers to participate in the unlawful claim
of an exemption;

(iii)
A vendor that accepts an exemption certificate from a consumer that
claims an exemption based on who purchases or who sells property or a
service, when the subject of the transaction sought to be covered by
the exemption certificate is actually received by the consumer at a
location operated by the vendor in this state, and this state has
posted to its web site an exemption certificate form that clearly and
affirmatively indicates that the claimed exemption is not available
in this state;

(iv)
A vendor that accepts an exemption certificate from a consumer who
claims a multiple points of use exemption under division (D) of
section 5739.033 of the Revised Code, if the item purchased is
tangible personal property, other than prewritten computer software.

(2)
The vendor shall maintain records, including exemption certificates,
of all sales on which a consumer has claimed an exemption, and
provide them to the tax commissioner on request.

(3)
The tax commissioner may establish an identification system whereby
the commissioner issues an identification number to a consumer that
is exempt from payment of the tax. The consumer must present the
number to the vendor, if any sale is claimed to be exempt as provided
in this section.

(4)
If no certificate is provided or obtained within ninety days after
the date on which such sale is consummated, it shall be presumed that
the tax applies. Failure to have so provided or obtained a
certificate shall not preclude a vendor, within one hundred twenty
days after the tax commissioner gives written notice of intent to
levy an assessment, from either establishing that the sale is not
subject to the tax, or obtaining, in good faith, a fully completed
exemption certificate.

(5)
Certificates need not be obtained nor provided where the identity of
the consumer is such that the transaction is never subject to the tax
imposed or where the item of tangible personal property sold or the
service provided is never subject to the tax imposed, regardless of
use, or when the sale is in interstate commerce.

(6)
If a transaction is claimed to be exempt under division (B)(13) of
section 5739.02 of the Revised Code, the contractor shall obtain
certification of the claimed exemption from the contractee. This
certification shall be in addition to an exemption certificate
provided by the contractor to the vendor. A contractee that provides
a certification under this division shall be deemed to be the
consumer of all items purchased by the contractor under the claim of
exemption, if it is subsequently determined that the exemption is not
properly claimed. The certification shall be in such form as the tax
commissioner prescribes.

(7)
If a transaction is claimed to be exempt under division (B)(13) of
section 5739.02 of the Revised Code, the person that leases a sports
facility, as defined in section 307.696 of the Revised Code, wholly
owned by a county may provide and sign, on behalf of the county, an
exemption certificate required under this section for that exemption.

(C)
As used in this division, "contractee" means a person who
seeks to enter or enters into a contract or agreement with a
contractor or vendor for the construction of real property or for the
sale and installation onto real property of tangible personal
property.

Any
contractor or vendor may request from any contractee a certification
of what portion of the property to be transferred under such contract
or agreement is to be incorporated into the realty and what portion
will retain its status as tangible personal property after
installation is completed. The contractor or vendor shall request the
certification by certified mail delivered to the contractee, return
receipt requested. Upon receipt of such request and prior to entering
into the contract or agreement, the contractee shall provide to the
contractor or vendor a certification sufficiently detailed to enable
the contractor or vendor to ascertain the resulting classification of
all materials purchased or fabricated by the contractor or vendor and
transferred to the contractee. This requirement applies to a
contractee regardless of whether the contractee holds a direct
payment permit under section 5739.031 of the Revised Code or provides
to the contractor or vendor an exemption certificate as provided
under this section.

For
the purposes of the taxes levied by this chapter and Chapter 5741. of
the Revised Code, the contractor or vendor may in good faith rely on
the contractee's certification. Notwithstanding division (B) of
section 5739.01 of the Revised Code, if the tax commissioner
determines that certain property certified by the contractee as
tangible personal property pursuant to this division is, in fact,
real property, the contractee shall be considered to be the consumer
of all materials so incorporated into that real property and shall be
liable for the applicable tax, and the contractor or vendor shall be
excused from any liability on those materials.

If
a contractee fails to provide such certification upon the request of
the contractor or vendor, the contractor or vendor shall comply with
the provisions of this chapter and Chapter 5741. of the Revised Code
without the certification. If the tax commissioner determines that
such compliance has been performed in good faith and that certain
property treated as tangible personal property by the contractor or
vendor is, in fact, real property, the contractee shall be considered
to be the consumer of all materials so incorporated into that real
property and shall be liable for the applicable tax, and the
construction contractor or vendor shall be excused from any liability
on those materials.

This
division does not apply to any contract or agreement where the tax
commissioner determines as a fact that a certification under this
division was made solely on the decision or advice of the contractor
or vendor.

(D)
Notwithstanding division (B) of section 5739.01 of the Revised Code,
whenever the total rate of tax imposed under this chapter is
increased after the date after a construction contract is entered
into, the contractee shall reimburse the construction contractor for
any additional tax paid on tangible property consumed or services
received pursuant to the contract.

(E)
A vendor who files a petition for reassessment contesting the
assessment of tax on sales for which the vendor obtained no valid
exemption certificates and for which the vendor failed to establish
that the sales were properly not subject to the tax during the
one-hundred-twenty-day period allowed under division (B) of this
section, may present to the tax commissioner additional evidence to
prove that the sales were properly subject to a claim of exception or
exemption. The vendor shall file such evidence within ninety days of
the receipt by the vendor of the notice of assessment, except that,
upon application and for reasonable cause, the period for submitting
such evidence shall be extended thirty days.

The
commissioner shall consider such additional evidence in reaching the
final determination on the assessment and petition for reassessment.

(F)
Whenever a vendor refunds the price, minus any separately stated
delivery charge, of an item of tangible personal property on which
the tax imposed under this chapter has been paid, the vendor shall
also refund the amount of tax paid, minus the amount of tax
attributable to the delivery charge.

Section
2.
That
existing sections 126.021, 126.024, 173.19, 1751.03, 3701.741,
3901.81, 3902.70, 3903.14, 3903.42, 3959.01, 3963.06, 4121.50,
4729.20, 4729.49, 4729.80, 4729.84, 4729.86, 5160.01, 5160.34,
5160.37, 5160.371, 5160.40, 5162.01, 5162.021, 5162.13, 5162.1310,
5162.73, 5164.01, 5164.38, 5164.46, 5164.74, 5164.751, 5166.01,
5166.40, 5166.405, 5166.406, 5168.75, 5168.76, 5739.01, and 5739.03
of the Revised Code are hereby repealed.

Section
3.
That
sections 1751.271, 3901.815, 3903.421, 5164.741, 5167.01, 5167.02,
5167.03, 5167.031, 5167.04, 5167.05, 5167.051, 5167.09, 5167.10,
5167.101, 5167.103, 5167.11, 5167.12, 5167.122, 5167.123, 5167.13,
5167.14, 5167.15, 5167.16, 5167.17, 5167.171, 5167.173, 5167.18,
5167.20, 5167.201, 5167.21, 5167.22, 5167.221, 5167.24, 5167.241,
5167.243, 5167.244, 5167.245, 5167.26, 5167.30, 5167.31, 5167.32,
5167.33, 5167.34, 5167.35, 5167.40, 5167.41, 5167.45, 5167.47, and
5739.051 of the Revised Code are hereby repealed.

Section
4.
This
act shall be known as the Medicaid Savings Act.