Section 5167.103 | Performance Metrics; Publication.
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 […]
Section 5167.11 | Managed Care Organization Contract to Provide Grievance Process.
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.
Section 5167.12 | Requirements When Prescribed Drugs Are Included in Care Management System.
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 […]
Section 5167.031 | Recognition of Pediatric Accountable Care Organizations.
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 […]
Section 5167.04 | Inclusion of Alcohol, Drug Addiction, and Mental Health Services in Care Management System.
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.
Section 5167.05 | Inclusion of Prescribed Drugs in 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.
Section 5167.051 | Coverage of Services Provided by Pharmacist.
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.
Section 5167.10 | Authority to Contract With Managed Care Orgainizations.
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 […]
Section 5167.101 | Basis of Hospital Inpatient Capital Payment Portion of Payment to Medicaid Managed Care Organization.
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 […]
Section 5167.102 | Use of Providers to Render Care to Enrollees.
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.