Section 5167.122 | Disclosure of Sources of Payment.
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, […]
Section 5167.123 | Medicaid Mco Contracts With 340b Program Participants.
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 […]
Section 5167.13 | Implementation of Coordinated Services Program for Enrollees Who Abuse Prescribed Drugs.
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 […]
Section 5167.14 | Data Security Agreements for Managed Care Organization’s Use of Drug Database.
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 […]
Section 5167.15 | Chiropractic Services.
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 […]
Section 5167.16 | Home Visits and Cognitive Behavioral Therapy.
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) […]
Section 5167.17 | Enhanced Care Management Services for Pregnant Women and Women Capable of Becoming Pregnant.
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 […]
Section 5167.171 | Uniform Prior Approval Form for Progesterone.
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.
Section 5167.173 | Community Health Worker Services or Services Provided by Public Health Nurse.
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 […]
Section 5167.18 | Identification of Fraud, Waste, and Abuse.
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.