Section 5167.33 | Strategies Regarding Payment to Providers.
Effective: September 29, 2015 Latest Legislation: House Bill 64 – 131st General Assembly (A) Not later than July 1, 2018, each medicaid managed care organization shall implement strategies that base payments to providers on the value received from the providers’ services, including their success in reducing waste in the provision of the services. Not later […]
Section 5167.34 | Immunity From Liability.
Effective: September 29, 2017 Latest Legislation: House Bill 49 – 132nd General Assembly A medicaid managed care organization, its officers, employees, or other persons associated with the managed care organization are not liable in a civil action for damages or other relief for furnishing information to the department of medicaid regarding potential fraud, waste, or […]
Section 5167.40 | Appointment of Temporary Manager.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly The department of medicaid shall appoint a temporary manager for a medicaid managed care organization if the department determines that the medicaid managed care organization has repeatedly failed to meet substantive requirements specified in the “Social Security Act,” sections 1903(m) and 1932, […]
Section 5167.41 | Disenrolling Some or All Medicaid Recipients From Mco Plan Offered by a Managed Care Organization.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid may disenroll some or all medicaid recipients from a medicaid MCO plan offered by a medicaid managed care organization if the department proposes to terminate or not to renew the contract entered into under section 5167.10 of the […]
Section 5167.45 | Information About Medicaid Recipients’ Races, Ethnicities, and Primary Languages.
Effective: April 6, 2017 Latest Legislation: Senate Bill 332 – 131st General Assembly The department of medicaid shall include information about medicaid recipients’ races, ethnicities, and primary languages in data the department shares with medicaid managed care organizations. Medicaid managed care organizations shall include this information in the data the organizations share with providers.
Section 5167.47 | Compliance With Federal Mental Health and Addiction Parity Laws.
Effective: March 24, 2021 Latest Legislation: Senate Bill 284 – 133rd General Assembly (A) When contracting with a medicaid managed care organization, the department of medicaid shall require the medicaid managed care organization to provide to medicaid enrollees the same benefits and rights as required under division (B) of section 3902.36 of the Revised Code. […]
Section 5167.26 | Records for Determining Costs.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly For the purpose of determining the amount the department of medicaid pays hospitals under section 5168.09 of the Revised Code and the amount of disproportionate share hospital payments paid by the medicare program pursuant to section 1915 of the “Social Security Act,” […]
Section 5167.30 | Managed Care Performance Payment Program.
Effective: September 29, 2017 Latest Legislation: House Bill 49 – 132nd General Assembly (A)(1) The department of medicaid shall establish a managed care performance payment program. Under the program, the department may provide payments to medicaid managed care organizations that meet performance standards established by the department. (2) In establishing performance standards, the department may […]
Section 5167.31 | Financial Incentive Awards.
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly The department of medicaid may provide financial incentive awards to medicaid managed care organizations that meet or exceed performance standards specified in provider agreements or rules adopted by the medicaid director under section 5167.02 of the Revised Code. The department may specify […]
Section 5167.32 | Improving Integrity of Care Management System.
Effective: September 29, 2015 Latest Legislation: House Bill 64 – 131st General Assembly Not later than July 1, 2016, the department of medicaid shall implement strategies to improve the integrity of the care management system, including strategies to do both of the following: (A) Increase the department’s oversight of medicaid managed care organizations; (B) Provide […]