Section 5167.221 | Assessment of Recoupment Efforts.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly The department of medicaid shall assess the efforts of medicaid managed care organizations to recoup overpayments made to providers who are network providers and providers who are not network providers. The assessments shall examine the amount of time recoupment efforts take starting […]
Section 5167.24 | Third-Party Administrator as Single Pharmacy Benefit Manager.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) If the department of medicaid includes prescribed drugs in the care management system as authorized under section 5167.05 of the Revised Code, the medicaid director, through a procurement process, shall select a third-party administrator to serve as the single pharmacy benefit […]
Section 5167.241 | State Pharmacy Benefit Manager Contract; Payment Arrangements.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A)(1) Medicaid managed care organizations shall use the state pharmacy benefit manager selected under section 5167.24 of the Revised Code pursuant to the terms of the master contract entered into under that section. All payment arrangements between the department of medicaid, medicaid […]
Section 5167.243 | Quarterly Reports.
Effective: October 17, 2019 Latest Legislation: House Bill 166 – 133rd General Assembly (A) The state pharmacy benefit manager shall provide to the medicaid director a written quarterly report containing the following information from the immediately preceding quarter: (1) The prices that the state pharmacy benefit manager negotiated for prescribed drugs under the care management […]
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 5167.18 | 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 5167.122 | 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 […]