Source: http://www.healthinfolaw.org/state-topics/36,55/f_topics
Timestamp: 2019-03-22 08:44:37
Document Index: 38624997

Matched Legal Cases: ['§ 3721', '§ 3712', '§ 5111', '§ 5111', '§ 5111', '§ 3712', '§ 5165', '§ 5167', '§ 5123', '§ 5166', '§ 5164', '§ 5167', '§ 3701', '§ 3701', '§ 4729', '§ 5123']

Care Coordination/Care Management in Ohio | Health Information & the Law
Care Coordination/Care Management in Ohio
Ohio law has enacted measures to ensure that every resident of the state has access to appropriate care. Every territory in the state will be designated as part of a health service area governed by a health service agency, which will work to identify the health care needs of the area and develop plans for addressing such needs.1 These community-based plans will be made a part of the overall resource plan for the state in an effort to more adequately provide care to all residents in the state.
Ohio has also instituted many measures to ensure that patients play an integral role in the management of their own care. Skilled nursing facility residents may select the physician of their choice, obtain information from their physician about their condition and treatment, participate in the planning of their own care, and give or refuse consent for treatment.2 Hospice programs must work with each patient and his family to create a coordinated plan of care for the patient.3
Ohio has also instituted measures to facilitate care management for patients to ensure continuity and quality of care. Nursing homes must provide a comprehensive assessment for residents,4 and on the basis of such assessment establish a comprehensive plan of care for each resident. When transferring or discharging a resident, the nursing home must establish a discharge plan for the resident and provide the transferee facility or care provider with the resident’s updated plan of care.5 Residential care facilities will conduct health assessments for all residents and will transfer or discharge the resident when the facility cannot meet the needs of the resident after meeting with the resident to discuss his condition and the options available to him.6
Care coordination and management are significant components of the state’s Medicaid program. A care management system has been established for the Medicaid program.7 Entities may receive recognition as pediatric accountable care organizations, which may develop partnerships with relevant groups to provide more streamlined care to Medicaid-eligible individuals under age 21.8 Home and community-based care services as part of Medicaid must establish a comprehensive plan of care for individuals receiving services, and must inform the participant of the services available to him and the choices available to the participant in accessing the necessary services.9 Managed health care programs also have a number of care coordination responsibilities, including the provision of care management services to coordinate and monitor treatment provided to certain members and the assignment of a primary care provider to each member to assist with care coordination.10 Managed care members have the right to be informed about their health and to participate in decisions involving their health care.11
2. Ohio Rev. Code § 3721.13
3. Ohio Rev. Code § 3712.06
4. Ohio Admin. Code 3701-17-10
5. Ohio Admin. Code 3701-17-14
6. Ohio Admin. Code 3701-17-58
7. Ohio Rev. Code § 5111.16
8. Ohio Rev. Code § 5111.161
9. Ohio Rev. Code § 5111.851
10. Ohio Admin. Code 5101:3-26-03.1
11. Ohio Admin. Code 5101:3-26-08.3
Treatment planning when using interdisciplinary team (including assessments, plan of care, discharge/transfer planning Admission of patients to the hospice care program – Ohio Admin. Code 3701-19-20 A hospice care program must comply with the following requirements: Admit patients, provide care and services, and discharge or transfer patients...
Admission; transfer; discharge – ambulatory surgical facilities – Ohio Admin. Code 3701-83-17 Each ambulatory surgical facility must conduct a comprehensive medical history, physical exam and pre-procedure studies for each patient before an...
General requirements for hospice care programs after licensure – Ohio Admin. Code 3701-19-07 As a condition of licensure, hospice programs are required to do the following: Establish an interdisciplinary plan of care for each hospice...
Interdisciplinary team and interdisciplinary plan of care – Ohio Admin. Code 3701-19-11 Each hospice care program must have an interdisciplinary team(s) that provides or supervises the provision of hospice care and services. The...
Level I service standards – Ohio Admin. Code 3701-7-09 “Level I service standards” A level I obstetrical service must provide antepartum care, intrapartum care, and postpartum care for...
Plan of care; treatment and care; discharge planning – Ohio Admin. Code 3701-17-14 An interdisciplinary team, including the resident and his family or sponsor, must develop a plan of care for each resident in a nursing home that...
Process and general standards – Ohio Admin. Code 173-43-02 “Process and General Standards” When an individual applies for admission to a nursing facility or when a nursing facility resident...
Provision of services – Ohio Rev. Code Ann. § 3712.06 Hospice programs must comply with the following requirements: Provide a planned and continuous hospice care program; Establish an...
Resident assessments; tuberculosis testing – Ohio Admin. Code 3701-17-10 Each nursing home must require a written initial and periodic assessment of all residents. Prior to admission of a resident, a nursing home...
Resident health assessments – Ohio Admin. Code 3701-17-58 Residential care facilities must conduct initial health assessments and annual reassessments (or sooner if medically indicated) of prospective and...
Discharge instructions/Required follow-up. Admission; transfer; discharge – ambulatory surgical facilities – Ohio Admin. Code 3701-83-17 Each ambulatory surgical facility must conduct a comprehensive medical history, physical exam and pre-procedure studies for each patient before an...
Licensure laws requiring or recommending care coordination or care management activities (Cross reference with private insurance/Medicaid/Medicare data requirements) Assessment to determine level of care – Ohio Rev. Code Ann. § 5165.04 “Assessment to determine level of care” The department of job and family services may require each applicant for or recipient of...
Care management system – Ohio Rev. Code Ann. § 5167.03 The department of job and family services will establish a care management system as part of the Medicaid program. The department may require...
Habilitation plan – Ohio Rev. Code Ann. § 5123.85 All institutionalized residents must receive a comprehensive evaluation, diagnosis, prognosis and description of habilitation goals within thirty...
Home and community-based services medicaid waiver components – Ohio Rev. Code Ann. § 5166.04 Home and community-based services Medicaid waiver components must meet the following requirements: A level of care determination must be made to...
Managed care programs: care coordination – Ohio Admin. Code 5160-26-03.1 Provider agreements between the Ohio department of job and family services and a provider of Medicaid covered services will contain the following...
Managed health care programs: member rights – Ohio Admin. Code 5160-26-08.3 Managed health care program members have the following rights: To be ensured of confidential handling of information concerning their diagnoses,...
Outpatient drug use review program – Ohio Rev. Code Ann. § 5164.759 The department of job and family services must establish an outpatient drug use review program to assure that prescriptions obtained by recipients of...
Patient care policies – Ohio Admin. Code 3701-83-07 Every healthcare facility must develop and follow comprehensive and effective patient care policies that include the following rights for each...
Recognition of pediatric accountable care organizations – Ohio Rev. Code Ann. § 5167.031 If the department of job and family services includes in the care management system individuals under age 21 in the category of individuals who...
Disease management Director to develop and administer AIDS and HIV related programs – Ohio Rev. Code Ann. § 3701.241 The director of health will have the following responsibilities with respect to AIDS and HIV –related programs: Develop a surveillance...
Other Fees for providing copies of medical records – Ohio Rev. Code Ann. § 3701.741 When a patient or a patient's personal representative requests a copy of the patient's medical record, the health care provider or medical records...
Information sharing across providers (including communication with other providers, across state lines, patient transfer) Information to be provided by licensees who personally furnish drugs to patients – Ohio Rev. Code Ann. § 4729.79 Each licensed health professional authorized to prescribe drugs who personally furnishes a controlled substance or other dangerous drug must submit...
Medical records – Ohio Admin. Code 3701-83-23.3 Each patient medical record maintained by a health care facility (HCF) must include the following information: Patient information...
Prospective drug utilization review – Ohio Admin. Code 4729-5-20 Prior to dispensing any prescription, a pharmacist must review the patient profile to identify the following information: Over-utilization or...
Care Coordination/Care Management Managed care programs: care coordination - Ohio Admin. Code 5101:3-26-03.1 Managed health care programs (MCP) must meet the following care coordination responsibilities: Ensure that each member has a primary care...
Managed health care programs: program integrity – fraud and abuse, audits, reporting, and record retention – Ohio Admin. Code 5160-26-06 Managed health care programs (MCPs) must have administrative and managed arrangements or procedures, including a mandatory compliance plan, to guard...
Informed consent requirements (If the information is going beyond the patient and provider Patient care policies – Ohio Admin. Code 3701-84-07 The provider of a health care service (HCS) must develop and follow comprehensive and effective patient care policies that include the...
Patient authorization requirements (to provide health information to another individual) Rights of persons with a developmental disability – Ohio Rev. Code Ann. § 5123.62 “Rights of persons with a developmental disability” Persons with mental retardation or a developmental disability have the...