Ohio Revised Code Search

...otice, statement, or order to a nursing facility under sections 5165.60 to 5165.66 and 5165.69 to 5165.89 of the Revised Code by certified mail, hand delivery, or other means reasonably calculated to provide prompt actual notice. If the notice, statement, or order is mailed, it shall be addressed to the administrator of the facility as indicated in the department's or agency's records. If it is hand delivered, it sha...

...r who have certain diagnoses or special care needs specified by the department or agency; (5) A fine imposed under section 5165.72, 5165.73, or 5165.74 of the Revised Code. (B) The department of medicaid or contracting agency may do any of the following prior to or during the pendency of any proceeding under Chapter 119. of the Revised Code: (1) Issue and execute an order under section 5165.72, 5165.77, or 5...

...e identity of any resident of a nursing facility; (b) The identity of any individual who submits a complaint about a nursing facility; (c) The identity of any individual who provides the department or agency with information about a nursing facility and has requested confidentiality; (d) Any information that reasonably would tend to disclose the identity of any individual described in division (A)(1)(a) to (c...

...resident is a medicaid recipient or medicare beneficiary.

...(A) Whoever violates section 5165.102 or division (E) of section 5165.08 of the Revised Code shall be fined not less than five hundred dollars nor more than one thousand dollars for the first offense and not less than one thousand dollars nor more than five thousand dollars for each subsequent offense. Fines paid under this section shall be deposited in the state treasury to the credit of the general revenue fund. (...

... as in 42 C.F.R. 438.2. (M) "Nursing facility services" has the same meaning as in section 5165.01 of the Revised Code. (N) "Part B drug" means a drug or biological described in section 1842(o)(1)(C) of the "Social Security Act," 42 U.S.C. 1395u(o)(1)(C). (O) "Pharmacy benefit manager" has the same meaning as in section 3959.01 of the Revised Code. (P) "Practice of pharmacy" has the same meaning as in sec...

...The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.

... a medicaid waiver component or nursing facility services are included in the care management system, except that ICDS participants may be required or permitted to obtain such services under the system. Medicaid recipients who receive such services may be designated for voluntary or mandatory participation in the system in order to receive other health care services included in the system. The department may requir...

... (c) Any other entity the department determines is qualified. (D) The medicaid director shall consult with all of the following in adopting rules authorized by division (E) of this section necessary for an entity to be recognized by the department as a pediatric accountable care organization: (1) The superintendent of insurance; (2) Children's hospitals; (3) Medicaid managed care organizations; (4) Any other...

...lth services covered by medicaid in the care management system.

... covered by the medicaid program in the care management system.

...edicaid may include the services in the care management system.

...1) Inpatient services; (2) Outpatient facility services; (3) Professional services; (4) Radiology, pathology, and laboratory services; (5) Pharmacy services; (6) Behavioral health services; (7) All other services. (C) As used in this section, "expansion eligibility group" has the same meaning as in section 5163.01 of the Revised Code.

...d may enter into contracts with managed care organizations under which the organizations are authorized to provide, or arrange for the provision of, health care services to medicaid recipients who are required or permitted to participate in the care management system.

... the payment made to a medicaid managed care organization on data for services provided to all of the organization's enrollees, as reported by hospitals on relevant cost reports submitted pursuant to rules adopted under section 5167.02 of the Revised Code. (B) The hospital inpatient capital payment portion of the payment made to medicaid managed care organizations shall not exceed any maximum rate established in ru...

...te the metrics the department uses to determine how well medicaid managed care organizations perform. The department shall update its internet web site each quarter to reflect any changes it makes to the metrics.

...Each medicaid managed care organization shall provide a grievance process for the organization's enrollees in accordance with 42 C.F.R. 438, subpart F.

...If prescribed drugs are included in the care management system: (A) Medicaid MCO plans may include strategies for the management of drug utilization, but any such strategies are subject to the limitations and requirements of this section and the approval of the department of medicaid. (B) A medicaid MCO plan shall not impose a prior authorization requirement in the case of a drug to which all of the following a...

...vices provided for the medicaid managed care organization. (B) Each medicaid managed care organization shall disclose to the department of medicaid in the format specified by the department the organization's administrative costs associated with providing pharmacy services under the care management system.

...cquisition cost rate for that drug as determined by the United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition cost of the drug, as defined in 42 U.S.C. 1395w-3a(c)(6)(B); (2) A fee that is not imposed on a health care provider that is not a 3...

...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 be implemented in a manner that is consistent with section 1915(a)(2) of the "Social Security Act," 42 U.S.C. 1396n(a)(2), and 42 C.F.R. 431.54...

...Each medicaid managed care organization shall enter into a data security agreement with the state board of pharmacy governing the managed care organization's use of the board's drug database established and maintained under section 4729.75 of the Revised Code. This section does not apply if the board no longer maintains the drug database.

...he Revised Code with a medicaid managed care organization, the department of medicaid shall require the organization to comply with section 5164.061 of the Revised Code as if the organization were the department. This section does not limit the authority of a medicaid managed care organization to implement measures designed to improve quality and reduce costs.

...tal health services provider, that is determined to be medically necessary through a depression screening conducted as part of a home visit. (C) A medicaid recipient qualifies to receive the services specified in division (B) of this section if the medicaid recipient is enrolled in the help me grow program, enrolled in the medicaid managed care organization providing or arranging for the services, and is either pr...

...Each medicaid managed care organization shall provide enhanced care management services for pregnant women and women capable of becoming pregnant in the communities specified in rules adopted under section 3701.142 of the Revised Code. The services shall be provided in a manner intended to decrease the incidence of prematurity, low birth weight, and infant mortality, as well as improve the overall health status of wo...