Rule 5160-58-01.1 | MyCare Ohio plans: application of general managed care rules.
(A) MyCare Ohio plans must comply with all of the requirements applicable to managed care organizations (MCOs) and managed care entities (MCEs) in the following rules:
(1) Rule 5160-26-05 of the Administrative Code;
(2) Rule 5160-26-05.1 of the Administrative Code;
(3) Rule 5160-26-06 of the Administrative Code;
(4) Rule 5160-26-08.3 of the Administrative Code;
(5) Rule 5160-26-09.1 of the Administrative Code;
(6) Rule 5160-26-10 of the Administrative Code; and
(7) Rule 5160-26-11 of the Administrative Code.
(B) For all rules listed in paragraph (A) of this rule, the following provisions apply to the MyCare Ohio program described in Chapter 5160-58 of the Administrative Code:
(1) All cross-references to rule 5160-26-01 of the Administrative Code are replaced by cross-references to rule 5160-58-01 of the Administrative Code.
(2) All cross-references to rule 5160-26-02 of the Administrative Code are replaced by cross-references to rule 5160-58-02 of the Administrative Code.
(3) All cross-references to rule 5160-26-02.1 of the Administrative Code are replaced by cross-references to rule 5160-58-02.1 of the Administrative Code.
(4) All cross-references to rule 5160-26-03 of the Administrative Code are replaced by cross-references to rule 5160-58-03 of the Administrative Code.
(5) All cross-references to rule 5160-26-03.1 of the Administrative Code are replaced by cross-references to rule 5160-58-03.1 of the Administrative Code.
(6) All cross-references to rule 5160-26-08.4 of the Administrative Code are replaced by cross-references to rule 5160-58-08.4 of the Administrative Code.
(C) The following rules in Chapter 5160-26 of the Administrative Code do not apply to MyCare Ohio, as they are replaced by corresponding rules in Chapter 5160-58 of the Administrative Code:
(1) Rule 5160-26-02 of the Administrative Code,
(2) Rule 5160-26-02.1 of the Administrative Code,
(3) Rule 5160-26-03 of the Administrative Code,
(4) Rule 5160-26-03.1 of the Administrative Code, and
(5) Rule 5160-26-08.4 of the Administrative Code.
(D) When an MCO holds provider agreements with the Ohio department of medicaid (ODM) for the MyCare Ohio and medicaid managed care programs or the Ohio resilience through integrated systems and excellence (OhioRISE) program, ODM may apply all of the applicable provisions in Chapter 5160-26 of the Administrative Code separately to each of the contracts.
Last updated April 10, 2024 at 9:39 AM
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