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 5164.7514 | Step Therapy Exemption Process.
Effective: April 5, 2019 Latest Legislation: Senate Bill 265 – 132nd General Assembly (A) All of the following shall apply to the step therapy exemption process established and implemented by the department of medicaid pursuant to division (B)(2) of section 5164.7512 of the Revised Code: (1) The process shall be clear and convenient. (2) The […]
Section 5164.7515 | Annual Benchmark for Prescribed Drug Spending Growth.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) Not later than July 1, 2020, the medicaid director shall establish an annual benchmark for prescribed drug spending growth under the medicaid program. If the director determines that prescribed drug spending in a given year is projected to exceed the benchmark […]
Section 5164.76 | Manner of Payment for Community Mental Health Service Providers or Facilities and Alcohol and Drug Addiction Services.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly (A) In rules adopted under section 5164.02 of the Revised Code, the medicaid director shall modify the manner or establish a new manner in which the following are paid under medicaid: (1) Community mental health service providers or facilities for providing community […]
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 5164.756 | Drug Rebate Agreement or Supplemental Drug Rebate Agreement for Medicaid Program Not Subject to Public Records Law.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly Any record, data, pricing information, or other information regarding a drug rebate agreement or a supplemental drug rebate agreement for the medicaid program that the department of medicaid receives from a pharmaceutical manufacturer or creates pursuant to negotiation of the agreement is […]
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 […]