Section 5167.33 | Strategies Regarding Payment to Providers.
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 […]
Section 5167.34 | Immunity From Liability.
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 […]
Section 5167.40 | Appointment of Temporary Manager.
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, […]
Section 5167.41 | Disenrolling Some or All Medicaid Recipients From Mco Plan Offered by a Managed Care Organization.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid may disenroll some or all medicaid recipients from a medicaid MCO plan offered by a medicaid managed care organization if the department proposes to terminate or not to renew the contract entered into under section 5167.10 of the […]
Section 5167.45 | Information About Medicaid Recipients’ Races, Ethnicities, and Primary Languages.
Effective: April 6, 2017 Latest Legislation: Senate Bill 332 – 131st General Assembly The department of medicaid shall include information about medicaid recipients’ races, ethnicities, and primary languages in data the department shares with medicaid managed care organizations. Medicaid managed care organizations shall include this information in the data the organizations share with providers.
Section 5167.47 | Compliance With Federal Mental Health and Addiction Parity Laws.
Effective: March 24, 2021 Latest Legislation: Senate Bill 284 – 133rd General Assembly (A) When contracting with a medicaid managed care organization, the department of medicaid shall require the medicaid managed care organization to provide to medicaid enrollees the same benefits and rights as required under division (B) of section 3902.36 of the Revised Code. […]
Section 5167.244 | Violations; Penalty.
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 […]
Section 5167.245 | Appeals Process.
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 […]
Section 5167.20 | Reference by Managed Care Organization to Noncontracting Participant.
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 […]
Section 5167.201 | Payment of Nonsystem Provider for Emergency Services.
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 […]