Effective: April 12, 2021 Latest Legislation: Senate Bill 263 – 133rd General Assembly As used in this chapter: (A) “340B covered entity” means an entity described in section 340B(a)(4) of the “Public Health Service Act,” 42 U.S.C. 256b(a)(4) and includes any pharmacy under contract with the entity to dispense drugs on behalf of the entity. […]
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly As part of the medicaid program, the department of medicaid shall establish a care management system. The department shall implement the system in some or all counties. The department shall designate the medicaid recipients who are required or permitted to participate in […]
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly (A) As used in this section: (1) “Children’s care network” means any of the following: (a) A children’s hospital; (b) A group of children’s hospitals; (c) A group of pediatric physicians. (2) “Children’s hospital” has the same meaning as in section 2151.86 […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid shall include alcohol, drug addiction, and mental health services covered by medicaid in the care management system.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid may include prescribed drugs covered by the medicaid program in the care management system.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly If the medicaid program covers the pharmacist services described in section 5164.14 of the Revised Code, the department of medicaid may include the services in the care management system.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid may enter into contracts with managed care organizations under which the organizations are authorized to provide, or arrange for the provision of, health care services to medicaid recipients who are required or permitted to participate in the care […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) Subject to division (B) of this section, the department of medicaid or its actuary shall base the hospital inpatient capital payment portion of the payment made to a medicaid managed care organization on data for services provided to all of the […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid shall allow a medicaid managed care organization to use providers to render care to the organization’s enrollees upon completion of the organization’s credentialing process.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly In addition to the managed care performance payment program created under section 5167.30 of the Revised Code, the department of medicaid shall establish performance metrics that will be used to evaluate and compare how medicaid managed care organizations perform under the contracts […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly Each medicaid managed care organization shall provide a grievance process for the organization’s enrollees in accordance with 42 C.F.R. 438, subpart F.
Effective: September 18, 2020 Latest Legislation: House Bill 11 – 133rd General Assembly If prescribed drugs are included in the care management system: (A) Medicaid MCO plans may include strategies for the management of drug utilization, but any such strategies are subject to the limitations and requirements of this section and the approval of the […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) The state pharmacy benefit manager shall, on request from the department of medicaid, disclose to the department all sources of payment it receives for prescribed drugs, including any financial benefits such as drug rebates, discounts, credits, clawbacks, fees, grants, chargebacks, reimbursements, […]
Effective: April 12, 2021 Latest Legislation: Senate Bill 263 – 133rd General Assembly (A) No contract between a medicaid managed care organization, including a third-party administrator, and a 340B covered entity shall contain any of the following provisions: (1) A payment rate for a prescribed drug that is less than the national average drug acquisition […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly Each medicaid managed care organization shall implement a coordinated services program for the organization’s enrollees who are found to have obtained prescribed drugs under the medicaid program at a frequency or in an amount that is not medically necessary. The program shall […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly Each medicaid managed care organization shall enter into a data security agreement with the state board of pharmacy governing the managed care organization’s use of the board’s drug database established and maintained under section 4729.75 of the Revised Code. This section does […]
Effective: June 13, 2022 Latest Legislation: House Bill 136 – 134th General Assembly When contracting under section 5167.10 of the Revised Code with a medicaid managed care organization, the department of medicaid shall require the organization to comply with section 5164.061 of the Revised Code as if the organization were the department. This section does […]
Effective: September 30, 2021 Latest Legislation: House Bill 110 – 134th General Assembly (A) As used in this section: (1) “Help me grow program” means the program established by the department of health pursuant to section 3701.61 of the Revised Code. (2) “Targeted case management” has the same meaning as in 42 C.F.R. 440.169(b). (B) […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly Each medicaid managed care organization shall provide enhanced care management services for pregnant women and women capable of becoming pregnant in the communities specified in rules adopted under section 3701.142 of the Revised Code. The services shall be provided in a manner […]
