Ohio Administrative Code Search

...r, if appropriate, the primary care provider, specialists, and other providers, as applicable, that is designed to effectively meet the enrollee's needs. (14) "Waiver services plan" is a component of the care plan that identifies specific goals, objectives and measurable outcomes for a waiver-enrolled member's health and functioning expected as a result of HCBS provided by both formal and informa...

...r, if appropriate, the primary care provider, specialists, and other providers, as applicable, that is designed to effectively meet the enrollee's needs. (14) "Waiver services plan" is a component of the care plan that identifies specific goals, objectives and measurable outcomes for a waiver-enrolled member's health and functioning expected as a result of HCBS provided by both formal and informa...

... best match needs and preserve existing provider-patient relationships. The process does not include manual intervention for assignment. (3) "Care management" means a collaborative, team based, and personalized approach that encompasses the full spectrum of care coordination activities, ranging from short term assistance to meet care gaps to long term, intensive and holistic care coordination for members with the m...

...nistrative Code. (E) When an MCP holds provider agreements with the Ohio department of medicaid (ODM) for the MyCare Ohio and medicaid managed care programs, ODM may apply all of the applicable provisions in Chapter 5160-26 of the Administrative Code separately to each of the contracts.

...nistrative 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.

...nistrative 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.

...Ohio department of medicaid (ODM) has a provider agreement with the plan applicable to the eligible individual's county of residence. (5) Nothing in this rule shall be construed to limit or in any way jeopardize an eligible individual's basic medicaid eligibility or eligibility for medicare or other non-medicaid benefits to which he or she may be entitled. (B) MyCare Ohio plan enrollment. (1) The following applies...

... department of medicaid (ODM) has a provider agreement with the MCOP applicable to the eligible individual's county of residence. (5) Nothing in this rule shall be construed to limit or in any way jeopardize an eligible individual's basic medicaid eligibility or eligibility for medicare or other non-medicaid benefits to which he or she may be entitled. (B) MyCare Ohio plan enrollment. (1) The f...

... ODM approves the termination. (6) The provider agreement between ODM and the plan is terminated or not renewed. The effective date of termination shall be the last day of the month of the provider agreement termination or nonrenewal. (7) The member is not eligible for enrollment in a plan for one of the reasons set forth in rule 5160-58-02 of the Administrative Code. (B) All of the following a...

... the third party coverage. (6) The provider agreement between ODM and the MCOP is terminated or not renewed. The effective date of termination shall be the date of provider agreement termination or nonrenewal. (7) The member is not eligible for enrollment in an MCOP for one of the reasons set forth in rule 5160-58-02 of the Administrative Code. (B) All of the following apply when enrollment...

... the third party coverage. (6) The provider agreement between ODM and the MCOP is terminated or not renewed. The effective date of termination shall be the date of provider agreement termination or nonrenewal. (7) The member is not eligible for enrollment in an MCOP for one of the reasons set forth in rule 5160-58-02 of the Administrative Code. (B) All of the following apply when enrollment...

...ent with an MCOP is terminated when the provider agreement between ODM and the MCOP is terminated or not renewed. The effective date of disenrollment is the date of the provider agreement termination or nonrenewal. The individual is reassigned to a new MCOP without a break in coverage in such a circumstance. (2) All of the following apply when enrollment in a MyCare Ohio plan ends for any of the reasons set forth in...

...e alternatives, choice of qualified providers available in the MyCare Ohio plan's provider panel and the options of institutional and community-based care, and he or she elects to receive MyCare Ohio waiver services. If the individual is unable to sign the agreement prior to waiver enrollment, the individual will submit an electronic signature or standard signature via regular mail, or otherwi...

...e alternatives, choice of qualified providers available in the MyCare Ohio plan's provider panel and the options of institutional and community-based care, and he or she elects to receive MyCare Ohio waiver services. If the individual is unable to sign the agreement prior to waiver enrollment, the individual will submit an electronic signature or standard signature via regular mail, or otherwi...

...rvice alternatives, choice of qualified providers available in the MyCare Ohio plan's provider panel and the options of institutional and community-based care, and he or she elects to receive MyCare Ohio services. If the member is unable to sign the agreement prior to waiver enrollment, the member submits an electronic signature and standard signature via regular mail, or otherwise provides a signature, in no instanc...

...ry medicaid services from an MCOP panel provider, the plan must adequately and timely cover the services out of panel until the plan is able to provide the services from a panel provider. (B) The MCOP may place appropriate limits on a service; (1) On the basis of medical necessity for the member's condition or diagnosis; or; (2) Except as otherwise specified in this rule, to available panel...

... medicaid services from an MCOP network provider, the MCOP must adequately and timely cover the services out of network until the MCOP is able to provide the services from a network provider. (B) The MCOP may place appropriate limits on a service; (1) On the basis of medical necessity for the member's condition or diagnosis; (2) Except as otherwise specified in this rule, to available network p...

... medicaid services from an MCOP network provider, the MCOP adequately and timely covers the services out of network until the MCOP is able to provide the services from a network provider. (B) The MCOP may place appropriate limits on a service; (1) On the basis of medical necessity for the member's condition or diagnosis; (2) Except as otherwise specified in this rule, to available network providers; or (3) For th...

...sure each member has a primary care provider (PCP) who will serve as an ongoing source of primary care and assist with care coordination appropriate to the member's needs. (1) The MCOP will ensure PCPs are in compliance with the following triage requirements. Members with: (a) Emergency care needs will be triaged and treated immediately on presentation at the PCP site; (b) Persistent sympto...

... ensures each member has a primary care provider (PCP) who serves as an ongoing source of primary care and assists with care coordination appropriate to the member's needs. (1) The MCOP ensures PCPs are in compliance with the following triage requirements. Members with: (a) Emergency care needs are triaged and treated immediately on presentation at the PCP site; (b) Persistent symptoms are treated no later than th...

... direction of approved waiver service providers. (A) A member may choose to receive MyCare Ohio waiver services from any combination of providers on the provider panel of the MyCare Ohio plan selected by the member pursuant to paragraph (B) of rule 5160-58-04 of the Administrative Code. (B) A member receiving waiver services from any MyCare Ohio waiver provider shall: (1) Participate with the ...

...waiver services from any combination of providers on the provider panel of the MyCare Ohio plan selected by the member pursuant to paragraph (B) of rule 5160-58-04 of the Administrative Code. (B) A member receiving waiver services from any MyCare Ohio waiver provider will: (1) Participate with the waiver service coordinator in the development of the person-centered services plan as defined in r...

...waiver services from any combination of providers on the provider panel of the MyCare Ohio plan selected by the member pursuant to paragraph (B) of rule 5160-58-04 of the Administrative Code. (B) A member receiving waiver services from any MyCare Ohio waiver provider : (1) Participates with the waiver service coordinator in the development of the person-centered services plan as defined in rule 5160-44-02 of the A...

... services (HCBS) waiver program and the providers eligible to furnish those services to members enrolled in the MyCare Ohio waiver. (B) Providers seeking to furnish services in the MyCare Ohio waiver program shall meet the requirements in Chapter 173-39, 5160-45 or 5160-44 of the Administrative Code, as appropriate. Prior to furnishing services to MyCare Ohio waiver recipients, the services must be ...

... services (HCBS) waiver program and the providers eligible to furnish those services to members enrolled in the MyCare Ohio waiver. (B) Providers seeking to furnish services in the MyCare Ohio waiver program meet the requirements in Chapter 173-39, 5160-45, 5160-46, or 5160-44 of the Administrative Code, as appropriate. (1) Waiver services can be furnished to MyCare Ohio waiver members, or if the services are doc...