Ohio Code 5160.35 – Recovery of medical support definitions
As used in sections 5160.35 to 5160.43 of the Revised Code:
Terms Used In Ohio Code 5160.35
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- medical assistance recipient: includes an individual applying for a medical assistance program, a former medical assistance recipient, or both. See Ohio Code 5160.01
- Person: includes an individual, corporation, business trust, estate, trust, partnership, and association. See Ohio Code 1.59
(A) “Information” means all of the following:
(1) An individual’s name, address, date of birth, and social security number;
(2) The group or plan number, or other identifier, assigned by a third party to a policy held by an individual or a plan in which the individual participates and the nature of the coverage;
(3) Any other data the medicaid director specifies in rules authorized by section 5160.43 of the Revised Code.
(B) “Medical support” means support specified as support for the purpose of medical care by order of a court or administrative agency.
(C)(1) Subject to division (C)(2) of this section, and except as provided in division (C)(3) of this section, “third party” means all of the following:
(a) A person authorized to engage in the business of sickness and accident insurance under Title XXXIX of the Revised Code;
(b) A person or governmental entity providing coverage for medical services or items to individuals on a self-insurance basis;
(c) A health insuring corporation as defined in section 1751.01 of the Revised Code;
(d) A group health plan as defined in 29 U.S.C. § 1167;
(e) A service benefit plan as referenced in 42 U.S.C. § 1396a(a)(25);
(f) A managed care organization;
(g) A pharmacy benefit manager;
(h) A third party administrator;
(i) Any other person or governmental entity that is, by law, contract, or agreement, responsible for the payment or processing of a claim for a medical item or service for a medical assistance recipient.
(2) Except when otherwise provided by the “Social Security Act,” section 1862(b), 42 U.S.C. § 1395y(b), a person or governmental entity listed in division (C)(1) of this section is a third party even if the person or governmental entity limits or excludes payments for a medical item or service in the case of a public assistance recipient.
(3) “Third party” does not include the program for children and youth with special health care needs established under section 3701.023 of the Revised Code.
Last updated October 6, 2023 at 11:53 AM