Ohio Revised Code Search

...years of age. A child who is determined eligible for medical assistance under Title XIX of the "Social Security Act" or child health assistance under Title XXI of the "Social Security Act" shall remain eligible for those benefits until the earlier of: (1) The end of a period, not to exceed forty-eight months, following the determination; (2) The date when the individual exceeds four years of age. (C) The wai...

...to provide reentry services to medicaid-eligible imprisoned individuals for ninety days before an imprisoned individual's expected release date. The benefits provided shall include: (1) Mental health services; (2) Behavioral health services; (3) Substance use disorder treatment and related services; (4) A thirty-day supply of prescription medication at the time of release, including medication administered by...

...t company, subsidiary company, jointly held company, or holding company with respect to the other entity. (C) "Care management system" means the system established under section 5167.03 of the Revised Code. (D) "Controlled substance" has the same meaning as in section 3719.01 of the Revised Code. (E) "Dual eligible individual" has the same meaning as in section 5160.01 of the Revised Code. (F) "Emergency ...

...ance with Chapter 119. of the Revised Code.

...A) As part of the medicaid program, the department of medicaid shall establish a care management system. The department shall implement the system in some or all counties. (B) The department shall designate the medicaid recipients who are required or permitted to participate in the care management system. Those who shall be required to participate in the system include medicaid recipients who receive cognitive beh...

...c accountable care organization may develop innovative partnerships between relevant groups and may contract directly or subcontract with the state to provide care coordination and other services to the medicaid recipients under twenty-one years of age described in this division who are permitted or required to participate in the care management system. (C)(1) To be recognized by the department as a pediatric ...

...The department of medicaid shall include alcohol, drug addiction, and mental health services covered by medicaid in the care management system.

...The department of medicaid may include prescribed drugs covered by the medicaid program in the care management system.

... program covers the pharmacist services described in section 5164.14 of the Revised Code, the department of medicaid may include the services in the care management system.

...for annual and quarterly cost reports, delineated by the following categories: (1) Adults for whom financial eligibility for the medicaid program is determined by utilizing the modified adjusted gross income standard and who are not members of the expansion eligibility group; (2) Children for whom financial eligibility for the medicaid program is determined by utilizing the modified adjusted gross income standard...

...The department of medicaid 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.

...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 rules adopted under section 5167.02 of the Revised Code. If a maximum rate is established, a medicaid managed care or...

...s 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.

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

... use that is indicated on the drug's labeling, as approved by the federal food and drug administration. (C) The department shall authorize a medicaid MCO plan to include a pharmacy utilization management program under which prior authorization through the program is established as a condition of obtaining a controlled substance pursuant to a prescription. (D) Each medicaid managed care organization and medicaid...

...cks, reimbursements, or other payments related to services 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.

...payment rate for a prescribed drug provided by a 340B grantee to an individual as a result of health care services provided by the grantee directly to the individual, that is less than the payment rate applied to health care providers that are not 340B grantees; (2) A fee that is not imposed on a health care provider that is not a 340B grantee; (3) A fee amount that exceeds the amount for a health care provider t...

...und 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(e).

...g 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.

...When contracting under section 5167.10 of the 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.

...m" means the program established by the department of health pursuant to section 5180.21 of the Revised Code. (2) "Targeted case management" has the same meaning as in 42 C.F.R. 440.169(b). (B) A medicaid managed care organization shall provide to a medicaid recipient who meets the criteria in division (C) of this section, or arrange for such recipient to receive, both of the following types of services: (1)...

...birth weight, and infant mortality, as well as improve the overall health status of women capable of becoming pregnant for the purpose of ensuring optimal future birth outcomes.

...Each medicaid managed care organization shall, if the organization requires practitioners to obtain prior approval before administering progesterone to the organization's enrollees who are pregnant, use a uniform prior approval form for progesterone that is not more than one page.

...formance community care coordination model (endorsed by the federal agency for healthcare research and quality, the national institutes of health, and the centers for medicare and medicaid services or their successors) or uses certified community health workers or public health nurses to connect at-risk individuals to health, housing, transportation, employment, education, and other social services; (b) Is a board ...

...d care organization shall comply with federal and state efforts to identify fraud, waste, and abuse in the medicaid program.