Ohio Revised Code Chapter 5167 - Medicaid Managed Care

• Section 5167.01 - Definitions.
  As used in this chapter: (A) "Controlled substance" has the same meaning as in section 3719.01 of the Revised Code. (B) "Dual eligible individual"...
• Section 5167.02 - Rules.
  The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the...
• Section 5167.03 - [Renumbered From 5111.16] Care Management System.
  As part of the medicaid program, the department of medicaid shall establish a care management system. The department shall implement the system in some...
• Section 5167.031 - [Renumbered From 5111.161] Recognition Of Pediatric Accountable Care Organizations.
  (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...
• Section 5167.04 - Inclusion Of Alcohol, Drug Addiction, And Mental Health Services In Care Management System.
  (A) Subject to division (B) of this section, the department of medicaid shall include alcohol, drug addiction, and mental health services covered by medicaid...
• Section 5167.31 - [Renumbered From 5111.171] Financial Incentive Awards.
  The department of medicaid may provide financial incentive awards to medicaid managed care organizations that meet or exceed performance standards specified in provider agreements...
• Section 5167.10 - [Renumbered From 5111.17] Authority To Contract For Managed Care System.
  (A) The department of medicaid may enter into contracts with managed care organizations, including health insuring corporations, under which the organizations are authorized to...
• Section 5167.11 - [Renumbered From 5111.177] Health Insuring Corporation Contract To Provide Grievance Process.
  When contracting under section 5167.10 of the Revised Code with a health insuring corporation that holds a certificate of authority under Chapter 1751. of...
• Section 5167.12 - [Renumbered From 5111.172] Requiring Coverage Of Prescribed Drugs For Medicaid Recipients.
  (A) When contracting under section 5167.10 of the Revised Code with a managed care organization that is a health insuring corporation, the department of...
• Section 5167.13 - [Renumbered From 5111.179] Contracts With Managed Care Organizations; Implementation Of Coordinated Services Program For Medicaid Recipients Who Abuse Prescribed Drugs.
  Each contract the department of medicaid enters into with a managed care organization under section 5167.10 of the Revised Code shall require the managed...
• Section 5167.14 - [Renumbered From 5111.1710] Data Security Agreements For Managed Care Organization's Use Of Drug Database.
  Each contract the department of medicaid enters into with a managed care organization under section 5167.10 of the Revised Code shall require the managed...
• Section 5167.16 - Home Visits And Cognitive Behavioral Therapy.
  (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...
• Section 5167.17 - Enhanced Care Management Services For Pregnant Women And Women Capable Of Becoming Pregnant.
  When contracting under section 5167.10 of the Revised Code with a managed care organization that is a health insuring corporation, the department of medicaid...
• Section 5167.20 - [Renumbered From 5111.162] Reference By Managed Care Organization To Noncontracting Participant.
  (A) Except as provided in division (B) of this section, when a participant in the care management system established under this chapter is enrolled...
• Section 5167.201 - [Renumbered From 5111.163] Payment Of Nonsystem Provider For Emergency Services.
  When a participant in the care management system established under this chapter is enrolled in a medicaid managed care organization and receives emergency services...
• Section 5167.21 - [Renumbered From 5111.982] Payments To Skilled Nursing Facility.
  (A) As used in this section: (1) "Covered skilled nursing facility services" has the same meaning as in the "Social Security Act," section 1888(e)(2)(A),...
• Section 5167.25 - [Renumbered From 5111.178] Application For Federal Medicaid Requirements Waiver.
  (A) The medicaid director shall determine whether a waiver of federal medicaid requirements is necessary to fulfill the requirements of section 3901.3814 of the...
• Section 5167.26 - [Renumbered From 5111.175] Records For Determining Costs.
  For the purpose of determining the amount the department of medicaid pays hospitals under section 5168.09 of the Revised Code and the amount of...
• Section 5167.30 - [Renumbered From 5111.1711] Managed Care Performance Payment Program.
  (A) (1) The department of medicaid shall establish a managed care performance payment program. Under the program, the department may provide payments to medicaid...
• Section 5167.32 - Improving Integrity Of Care Management System.
  Not later than July 1, 2016, the department of medicaid shall implement strategies to improve the integrity of the care management system, including strategies...
• Section 5167.33 - Strategies Regarding Payment To Providers.
  (A) Not later than July 1, 2018, each medicaid managed care organization shall implement strategies that base payments to providers on the value received...
• Section 5167.40 - [Renumbered From 5111.173] Appointment Of Temporary Manager.
  The department of medicaid shall appoint a temporary manager for a medicaid managed care organization if the department determines that the medicaid managed care...
• Section 5167.41 - [Renumbered From 5111.174] Disenrolling Some Or All Medicaid Recipients Enrolled In Managed Care Organization.
  The department of medicaid may disenroll some or all medicaid recipients enrolled in a medicaid managed care organization if the department proposes to terminate...

Last modified: October 10, 2016