reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5167.03 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.03 | Care Management System.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|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. 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 behavioral therapy as described in division (A)(2) of section 5167.16 of the Revised Code. Except as provided in section 5166.406 of the Revised Code, no medicaid recipient participating in the healthy Ohio program established under section 5166.40 of the Revised Code shall participate in the system. The general assembly's authorization through the enactment of legislation is needed before home and community-based services available under 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 require or permit participants in the care management system to do either or both of the following: (A) Obtain health care services from providers designated by the department; (B) Enroll in a medicaid MCO plan.
Ohio Rev Code § 5167.04 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.04 | Inclusion of Alcohol, Drug Addiction, and Mental Health Services in Care Management System.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The department of medicaid shall include alcohol, drug addiction, and mental health services covered by medicaid in the care management system.
Ohio Rev Code § 5167.05 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.05 | Inclusion of Prescribed Drugs in Care Management System.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The department of medicaid may include prescribed drugs covered by the medicaid program in the care management system.
Ohio Rev Code § 5167.051 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.051 | Coverage of Services Provided by Pharmacist.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|If the medicaid 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.
Ohio Rev Code § 5167.10 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.10 | Authority to Contract With Managed Care Orgainizations.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|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.
Ohio Rev Code § 5167.101 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.101 | Basis of Hospital Inpatient Capital Payment Portion of Payment to Medicaid Managed Care Organization.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) Subject to division (B) of this section, the department of medicaid or its actuary shall base the hospital inpatient capital payment portion of 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 rules adopted under section 5167.02 of the Revised Code. If a maximum rate is established, a medicaid managed care organization shall not compensate hospitals for inpatient capital costs in an amount that exceeds that rate.
Ohio Rev Code § 5167.102 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.102 | Use of Providers to Render Care to Enrollees.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The department of medicaid shall allow a medicaid managed care organization to use providers to render care to the organization's enrollees upon completion of the organization's credentialing process.
Ohio Rev Code § 5167.103 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.103 | Performance Metrics; Publication.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|In addition to the managed care performance payment program created under section 5167.30 of the Revised Code, the department of medicaid shall establish performance metrics that will be used to evaluate and compare how medicaid managed care organizations perform under the contracts entered into under section 5167.10 of the Revised Code. The performance metrics may include financial incentives and penalties. The department shall make available on its internet web site 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.
Ohio Rev Code § 5167.11 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.11 | Managed Care Organization Contract to Provide Grievance Process.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|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.
Ohio Rev Code § 5167.12 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.12 | Requirements When Prescribed Drugs Are Included in Care Management System.

Effective: September 18, 2020|Latest Legislation:  House Bill 11 - 133rd General Assembly|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 apply:  (1) The drug is an antidepressant or antipsychotic.  (2) The drug is administered or dispensed in a standard tablet or capsule form, except that in the case of an antipsychotic, the drug also may be administered or dispensed in a long-acting injectable form.  (3) The drug is prescribed by any of the following:  (a) A physician whom the medicaid managed care organization that offers the plan allows to provide care as a psychiatrist through its credentialing process;  (b) A psychiatrist who is practicing at a location on behalf of a community mental health services provider whose mental health services are certified by the department of mental health and addiction services under section 5119.36 of the Revised Code;  (c) A certified nurse practitioner, as defined in section 4723.01 of the Revised Code, who is certified in psychiatric mental health by a national certifying organization approved by the board of nursing under section 4723.46 of the Revised Code;  (d) A clinical nurse specialist, as defined in section 4723.01 of the Revised Code, who is certified in psychiatric mental health by a national certifying organization approved by the board of nursing under section 4723.46 of the Revised Code.  (4) The drug is prescribed for a 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 MCO plan shall comply with sections 5164.091, 5164.10, 5164.7511, 5164.7512, and 5164.7514 of the Revised Code as if the organization were the department and the plan were the medicaid program.
Ohio Rev Code § 5167.122 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.122 | Disclosure of Sources of Payment.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) The state pharmacy benefit manager shall, on request from the department of medicaid, disclose to the department all sources of payment it receives for prescribed drugs, including any financial benefits such as drug rebates, discounts, credits, clawbacks, fees, grants, chargebacks, 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.
Ohio Rev Code § 5167.123 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.123 | Medicaid Mco Contracts With 340b Program Participants.

Effective: April 12, 2021|Latest Legislation:  Senate Bill 263 - 133rd General Assembly|(A) No contract between a medicaid managed care organization, including a third-party administrator, and a 340B covered entity shall contain any of the following provisions: (1) A payment rate for a prescribed drug that is less than the national average drug acquisition 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 340B covered entity; (3) A fee amount that exceeds the amount for a health care provider that is not a 340B covered entity. (B) The organization, or its contracted third-party administrators, shall not discriminate against a 340B covered entity in a manner that prevents or interferes with a medicaid recipient's choice to receive a prescription drug from a 340B covered entity or its contracted pharmacies. (C) Any provision of a contract entered into between the organization and a 340B covered entity that is contrary to division (A) of this section is unenforceable and shall be replaced with the dispensing fee or payment rate that applies for health care providers that are not 340B covered entities.
Ohio Rev Code § 5167.13 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.13 | Implementation of Coordinated Services Program for Enrollees Who Abuse Prescribed Drugs.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|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(e).
Ohio Rev Code § 5167.14 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.14 | Data Security Agreements for Managed Care Organization's Use of Drug Database.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|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.
Ohio Rev Code § 5167.16 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.16 | Home Visits and Cognitive Behavioral Therapy.

Effective: September 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|(A) As used in this section: (1) "Help me grow program" means the program established by the department of health pursuant to section 3701.61 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) Home visits, which shall include depression screenings, for which federal financial participation is available under the targeted case management benefit; (2) Cognitive behavioral therapy, provided by a community mental 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 pregnant or the birth mother of a child under five years of age. (D) If requested by a medicaid recipient eligible for the cognitive behavioral therapy covered under division (B)(2) of this section, the therapy shall be provided in the recipient's home. The medicaid managed care organization shall inform the medicaid recipient of the right to make the request and how to make it. Last updated August 12, 2021 at 3:39 PM
Ohio Rev Code § 5167.17 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.17 | Enhanced Care Management Services for Pregnant Women and Women Capable of Becoming Pregnant.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|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 women capable of becoming pregnant for the purpose of ensuring optimal future birth outcomes.
Ohio Rev Code § 5167.171 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.171 | Uniform Prior Approval Form for Progesterone.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|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.
Ohio Rev Code § 5167.18 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.18 | Identification of Fraud, Waste, and Abuse.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|Each medicaid managed care organization shall comply with federal and state efforts to identify fraud, waste, and abuse in the medicaid program.
Ohio Rev Code § 5167.20 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.20 | Reference by Managed Care Organization to Noncontracting Participant.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|(A) Except as provided in division (B) of this section, when a medicaid managed care organization refers an enrollee to receive services, other than emergency services provided on or after January 1, 2007, at a hospital that participates in the medicaid program but is not under contract with the organization, the hospital shall provide the service for which the referral was made and shall accept from the organization, as payment in full, the amount derived from the payment rate used by the department of medicaid to pay other hospitals of the same type for providing the same service to a medicaid recipient who is not enrolled in a medicaid MCO plan. (B) A hospital is not subject to division (A) of this section if all of the following are the case: (1) The hospital is located in a county in which participants in the care management system are required before January 1, 2006, to be enrolled in a medicaid MCO plan; (2) The hospital has entered into a contract before January 1, 2006, with at least one health insuring corporation serving the participants specified in division (B)(1) of this section; (3) The hospital remains under contract with at least one health insuring corporation serving participants in the care management system who are required to be enrolled in a medicaid MCO plan.  (C) The medicaid director shall adopt rules under section 5167.02 of the Revised Code specifying the circumstances under which a medicaid managed care organization is permitted to refer an enrollee to a hospital that is not under contract with the organization.
Ohio Rev Code § 5167.201 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.201 | Payment of Nonsystem Provider for Emergency Services.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|When a medicaid managed care organization's enrollee receives emergency services on or after January 1, 2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the amounts (less any payments for indirect costs of medical education and direct costs of graduate medical education) that the provider could collect if the enrollee received medicaid other than through enrollment in a medicaid MCO plan.  An agreement entered into by an enrollee, an enrollee's parent, or an enrollee's legal guardian that requires payment for emergency services in violation of this section is void and unenforceable.
Ohio Rev Code § 5167.21 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.21 | Payments to Skilled Nursing Facility.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) As used in this section: (1) "Covered skilled nursing facility services" has the same meaning as in the "Social Security Act," section 1888(e)(2)(A), 42 U.S.C. 1395yy(e)(2)(A).(2) "Current medicare fee-for-service rate" means the fee-for-service rate in effect for a covered skilled nursing facility service under medicare at the time the service is provided.(3) "Skilled nursing facility" has the same meaning as in the "Social Security Act," section 1819(a), 42 U.S.C. 1395i-3(a).(B) Except as provided in division (C) of this section, a medicaid managed care organization shall pay a skilled nursing facility at least the current medicare fee-for-service rate, without deduction for any coinsurance, for covered skilled nursing facility services that the skilled nursing facility provides to a dual eligible individual if the medicaid managed care organization is responsible for the payment under the terms of a contract that the medicaid managed care organization, medicaid director, and United States secretary of health and human services jointly enter into under the integrated care delivery system authorized by section 5164.91 of the Revised Code.(C) A medicaid managed care organization is required to pay the rate specified in division (B) of this section for covered skilled nursing facility services only if all of the following apply:(1) The United States secretary agrees to the payment rate as part of the contract that the medicaid managed care organization, medicaid director, and United States secretary jointly enter into under the integrated care delivery system;(2) The medicaid managed care organization receives a federal capitation payment that is an actuarially sufficient amount for the costs that the medicaid managed care organization incurs in paying the rate;(3) No state funds are used for any part of the costs that the medicaid managed care organization incurs in paying the rate;(4) The integrated care delivery system provides for dual eligible individuals to receive the covered skilled nursing facility services as part of the system.
Ohio Rev Code § 5167.22 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.22 | Recoupment of Overpayment.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|When a medicaid managed care organization seeks to recoup an overpayment made to a provider, it shall provide the provider all of the details of the recoupment, including all of the following information: (A) The name, address, and medicaid identification number of the enrollee to whom the services were provided; (B) The date or dates that the services were provided; (C) The reason for the recoupment;  (D) The method by which the provider may contest the proposed recoupment.
Ohio Rev Code § 5167.221 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5167 | Medicaid Managed Care|Section 5167.221 | Assessment of Recoupment Efforts.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The department of medicaid shall assess the efforts of medicaid managed care organizations to recoup overpayments made to providers who are network providers and providers who are not network providers. The assessments shall examine the amount of time recoupment efforts take starting from the time providers receive final payment and ending when the recoupment effort is completed. Each medicaid managed care organization shall submit to the department information regarding such recoupment efforts that the department needs to perform the assessments. The department shall specify what information is so needed. Following the assessments, the department shall include in the contracts entered into with medicaid managed care organizations under section 5167.10 of the Revised Code terms the department determines are reasonable to establish limits on such recoupment efforts. The terms shall include exceptions for cases of fraud and other types of deception.