Ohio Revised Code|Chapter 5167 | Medicaid Managed Care

Section 5167.01 | Definitions.

Section 5167.02 | Rules.

Section 5167.03 | Care management system.

Section 5167.031 | Recognition of pediatric accountable care organizations.

Section 5167.04 | Inclusion of alcohol, drug addiction, and mental health services in care management system.

Section 5167.05 | Inclusion of prescribed drugs in care management system.

Section 5167.051 | Coverage of services provided by pharmacist.

Section 5167.10 | Authority to contract with managed care orgainizations.

Section 5167.101 | Basis of hospital inpatient capital payment portion of payment to medicaid managed care organization.

Section 5167.102 | Use of providers to render care to enrollees.

Section 5167.103 | Performance metrics; publication.

Section 5167.11 | Managed care organization contract to provide grievance process.

Section 5167.12 | Requirements when prescribed drugs are included in care management system.

Section 5167.122 | Disclosure of sources of payment.

Section 5167.123 | Medicaid MCO contracts with 340B program participants.

Section 5167.13 | Implementation of coordinated services program for enrollees who abuse prescribed drugs.

Section 5167.14 | Data security agreements for managed care organization's use of drug database.

Section 5167.16 | Home visits and cognitive behavioral therapy.

Section 5167.17 | Enhanced care management services for pregnant women and women capable of becoming pregnant.

Section 5167.171 | Uniform prior approval form for progesterone.

Section 5167.173 | Community health worker services or services provided by public health nurse.

Section 5167.18 | Identification of fraud, waste, and abuse.

Section 5167.20 | Reference by managed care organization to noncontracting participant.

Section 5167.201 | Payment of nonsystem provider for emergency services.

Section 5167.21 | Payments to skilled nursing facility.

Section 5167.22 | Recoupment of overpayment.

Section 5167.221 | Assessment of recoupment efforts.

Section 5167.24 | Third-party administrator as single pharmacy benefit manager.

Section 5167.241 | State pharmacy benefit manager contract; payment arrangements.

Section 5167.243 | Quarterly reports.

Section 5167.244 | Violations; penalty.

Section 5167.245 | Appeals process.

Section 5167.26 | Records for determining costs.

Section 5167.30 | Managed care performance payment program.

Section 5167.31 | Financial incentive awards.

Section 5167.32 | Improving integrity of care management system.

Section 5167.33 | Strategies regarding payment to providers.

Section 5167.34 | Immunity from liability.

Section 5167.40 | Appointment of temporary manager.

Section 5167.41 | Disenrolling some or all medicaid recipients from MCO plan offered by a managed care organization.

Section 5167.45 | Information about medicaid recipients' races, ethnicities, and primary languages.

Section 5167.47 | Compliance with federal mental health and addiction parity laws.

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