Ohio § 1751.78

§ 1751.78.

(A)(1) Sections 1751.77 to 1751.87 and Chapter 3922. of the Revised Code apply to any health

insuring corporation that provides or performs utilization review services in connection

with its policies, contracts, and agreements covering basic health care services and

to any designee of the health insuring corporation, or to any utilization review organization

that performs utilization review functions on behalf of the health insuring corporation

in connection with policies, contracts, or agreements of the health insuring corporation

covering basic health care services. (2) Nothing in sections 1751.77 to 1751.82 or section 1751.823 of the Revised Code shall be construed to require a health insuring corporation to provide or perform

utilization review services in connection with health care services provided under

a policy, plan, or agreement of supplemental health care services or specialty health

care services. (B)(1) Each health insuring corporation shall be responsible for monitoring all utilization

review and internal review activities carried out by, or on behalf of, the health

insuring corporation and for ensuring that all requirements of sections 1751.77 to 1751.87 and Chapter 3922 . of the Revised Code, and any rules adopted thereunder, are met.  The health insuring corporation shall also ensure that appropriate personnel have

operational responsibility for the conduct of the health insuring corporation's utilization

review program. (2) If a health insuring corporation contracts to have a utilization review organization

or other entity perform the utilization review functions required by sections 1751.77 to 1751.87 and Chapter 3922 . of the Revised Code, and any rules adopted thereunder, the superintendent of insurance

shall hold the health insuring corporation responsible for monitoring the activities

of the utilization review organization or other entity and for ensuring that the requirements

of those sections and rules are met.