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.
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 5166.403 | Debit Swipe Cards.
Effective: September 29, 2015 Latest Legislation: House Bill 64 – 131st General Assembly (A) A managed care organization that offers the health plan in which a healthy Ohio program participant enrolls shall issue a debit swipe card to be used to pay only for the following: (1) Until the amount of the noncore portion of […]
Section 5166.404 | Points Award System.
Effective: September 29, 2015 Latest Legislation: House Bill 64 – 131st General Assembly (A) The medicaid director shall establish a system under which points are awarded in accordance with this section to healthy Ohio program debit swipe cards. One dollar of medicaid funds shall be deposited into a healthy Ohio program participant’s buckeye account for […]
Section 5166.405 | Cessation of Participation.
Effective: September 29, 2017 Latest Legislation: House Bill 49 – 132nd General Assembly (A) A healthy Ohio program participant’s participation in the program shall cease if any of the following applies: (1) Unless the participant is pregnant, a monthly installment payment to the participant’s buckeye account is sixty days late. (2) The participant fails to […]
Section 5166.406 | Exhaustion of Payout Limits.
Effective: September 29, 2015 Latest Legislation: House Bill 64 – 131st General Assembly If a healthy Ohio program participant exhausts the annual or lifetime payout limits specified in division (D) of section 5166.401 of the Revised Code, the participant shall be transferred to the fee-for-service component of medicaid or the care management system. A participant […]