Section 5164.761 | Beta Testing of Updates to Billing Codes or Payment Rates.
Effective: September 29, 2017 Latest Legislation: House Bill 49 – 132nd General Assembly Before the department of medicaid or department of mental health and addiction services updates medicaid billing codes or medicaid payment rates for community behavioral health services as part of the behavioral health redesign, the departments shall conduct a beta test of the […]
Section 5164.757 | E-Prescribing Applications.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly (A) As used in this section, “licensed health professional authorized to prescribe drugs” has the same meaning as in section 4729.01 of the Revised Code. (B) The medicaid director may acquire or specify technologies to provide information regarding medicaid recipient eligibility, claims […]
Section 5164.758 | Adoption of Rules for Implementation of Coordinated Services Program for Medicaid Users Who Abuse Prescription Drugs.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly The medicaid director shall adopt rules under section 5164.02 of the Revised Code to implement a coordinated services program for medicaid recipients who are found to have obtained prescribed drugs under the medicaid program at a frequency or in an amount that […]
Section 5164.759 | Outpatient Drug Use Review Program.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly In accordance with the “Social Security Act,” section 1927(g), 42 U.S.C. 1396r-8(g), the department of medicaid shall establish an outpatient drug use review program to assure that prescriptions obtained by medicaid recipients are appropriate, medically necessary, and unlikely to cause adverse medical […]
Section 5164.7510 | Pharmacy and Therapeutics Committee.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) There is hereby established the pharmacy and therapeutics committee of the department of medicaid. The committee shall assist the department with developing and maintaining a preferred drug list for the medicaid program. The committee shall review and recommend to the medicaid […]
Section 5164.7511 | Medication Synchronization for Medicaid Recipients.
Effective: March 22, 2020 Latest Legislation: Senate Bill 229 – 132nd General Assembly (A) As used in this section: (1) “Cost-sharing” means any cost-sharing requirements instituted for the medicaid program under section 5162.20 of the Revised Code. (2) “Medication synchronization” means a pharmacy service that synchronizes the filling or refilling of prescriptions in a manner […]
Section 5164.7512 | Definitions for Sections 5164.7512 to 5164.7514.
Effective: April 5, 2019 Latest Legislation: Senate Bill 265 – 132nd General Assembly (A) As used in sections 5164.7512 to 5164.7514 of the Revised Code: (1) “Clinical practice guidelines” means a systematically developed statement to assist providers and medicaid recipients in making decisions about appropriate health care for specific clinical circumstances and conditions. (2) “Clinical […]
Section 5164.73 | Division of Payments Between Physician or Podiatrist and Nurse.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly The division of any medicaid payment between a collaborating physician or podiatrist and a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner for services performed by the nurse shall be determined and agreed on by the nurse and collaborating physician or […]
Section 5164.74 | Reimbursement of Graduate Medical Education Costs.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly 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 […]
Section 5164.741 | Payment for Graduate Medical Education Costs to Noncontracting Hospitals.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly (A) Except as provided in division (B) of this section, the department of medicaid may deny medicaid payment to a hospital for direct graduate medical education costs associated with the delivery of medicaid services to any medicaid recipient if the hospital refuses […]