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.
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 […]