Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly Each medicaid managed care organization shall, if the organization requires practitioners to obtain prior approval before administering progesterone to the organization’s enrollees who are pregnant, use a uniform prior approval form for progesterone that is not more than one page.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) As used in this section: (1) “Board of health” means the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code. (2) “Certified […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly Each medicaid managed care organization shall comply with federal and state efforts to identify fraud, waste, and abuse in the medicaid program.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) Except as provided in division (B) of this section, when a medicaid managed care organization refers an enrollee to receive services, other than emergency services provided on or after January 1, 2007, at a hospital that participates in the medicaid program […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly When a medicaid managed care organization’s enrollee receives emergency services on or after January 1, 2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the […]
Effective: September 29, 2013 Latest Legislation: House Bill 59 – 130th General Assembly (A) As used in this section: (1) “Covered skilled nursing facility services” has the same meaning as in the “Social Security Act,” section 1888(e)(2)(A), 42 U.S.C. 1395yy(e)(2)(A). (2) “Current medicare fee-for-service rate” means the fee-for-service rate in effect for a covered skilled […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly When a medicaid managed care organization seeks to recoup an overpayment made to a provider, it shall provide the provider all of the details of the recoupment, including all of the following information: (A) The name, address, and medicaid identification number of […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid shall assess the efforts of medicaid managed care organizations to recoup overpayments made to providers who are network providers and providers who are not network providers. The assessments shall examine the amount of time recoupment efforts take starting […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) If the department of medicaid includes prescribed drugs in the care management system as authorized under section 5167.05 of the Revised Code, the medicaid director, through a procurement process, shall select a third-party administrator to serve as the single pharmacy benefit […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A)(1) Medicaid managed care organizations shall use the state pharmacy benefit manager selected under section 5167.24 of the Revised Code pursuant to the terms of the master contract entered into under that section. All payment arrangements between the department of medicaid, medicaid […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) The state pharmacy benefit manager shall provide to the medicaid director a written quarterly report containing the following information from the immediately preceding quarter: (1) The prices that the state pharmacy benefit manager negotiated for prescribed drugs under the care management […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly No person shall violate the terms of the master state pharmacy benefit manager contract under section 5167.24 of the Revised Code or section 5167.241 of the Revised Code. Whoever violates those sections is subject to a civil penalty in an amount to […]
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The medicaid director shall establish an appeals process by which pharmacies may appeal to the department of medicaid any disputes relating to the maximum allowable cost set by the state pharmacy benefit manager for a prescribed drug. All pharmacies participating in the […]
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,” […]
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 […]
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 […]
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 […]
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 […]
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 […]
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, […]
