Medicaid Managed Care | Midpage

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Ohio Revised Code

Chapter 5167

Medicaid Managed Care

5167.01Definitions 5167.02Rules 5167.03Care management system 5167.031Recognition of pediatric accountable care organizations 5167.04Inclusion of alcohol, drug addiction, and mental health services in care management system 5167.05Inclusion of prescribed drugs in care management system 5167.051Coverage of services provided by pharmacist 5167.09Managed care financial dashboard information 5167.10Authority to contract with managed care orgainizations 5167.101Basis of hospital inpatient capital payment portion of payment to medicaid managed care organization 5167.103Performance metrics; publication 5167.11Managed care organization contract to provide grievance process 5167.12Requirements when prescribed drugs are included in care management system 5167.122Disclosure of sources of payment 5167.123Medicaid MCO contracts with 340B program participants 5167.13Implementation of coordinated services program for enrollees who abuse prescribed drugs 5167.14Data security agreements for managed care organization's use of drug database 5167.15Chiropractic services 5167.16Home visits and cognitive behavioral therapy 5167.17Enhanced care management services for pregnant women and women capable of becoming pregnant 5167.171Uniform prior approval form for progesterone 5167.173Community health worker services or services provided by public health nurse 5167.18Identification of fraud, waste, and abuse 5167.20Reference by managed care organization to noncontracting participant 5167.201Payment of nonsystem provider for emergency services 5167.21Payments to skilled nursing facility 5167.22Recoupment of overpayment 5167.221Assessment of recoupment efforts 5167.24Third-party administrator as single pharmacy benefit manager 5167.241State pharmacy benefit manager contract; payment arrangements 5167.243Quarterly reports 5167.244Violations; penalty 5167.245Appeals process 5167.26Records for determining costs 5167.30Managed care performance payment program 5167.31Financial incentive awards 5167.32Improving integrity of care management system 5167.33Strategies regarding payment to providers 5167.34Immunity from liability 5167.35Meaningful employment of Medicaid recipients 5167.40Appointment of temporary manager 5167.41Disenrolling some or all medicaid recipients from MCO plan offered by a managed care organization 5167.45Information about medicaid recipients' races, ethnicities, and primary languages 5167.47Compliance with federal mental health and addiction parity laws