Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-1 - General Provisions › Section 5160-1-73 - Behavioral health care coordination

Current through all regulations passed and filed through July 1, 2024
(A)
								For the purpose
			 of this rule, the following definitions apply.
(1)
									"Attributed
			 individual" is the Ohio medicaid covered individual for whom a qualified
			 behavioral health entity eligible under this rule has accountability for
			 providing behavioral health care coordination.
(2)
									"Attribution" is
			 the process through which medicaid covered individuals are assigned to a
			 specific qualified behavioral health entity. The Ohio department of medicaid
			 (ODM) is responsible for attributing eligible individuals.
(3)
									"Behavioral
			 health care coordination" (BHCC) is an evidence-based comprehensive care
			 coordination model that connects qualified behavioral health entities with an
			 assigned panel of eligible members with high-need behavioral health
			 conditions.
(4)
									"Comprehensive primary care initiative" (CPC) is the
			 ODM implementation of a patient-centered medical home (PCMH) model as
			 established through rules
			 5160-1-71
			 and
			 5160-1-72
			 of the Administrative Code.
(5)
									"Consolidated
			 clinical document architecture" (C-CDA) is an implementation guide developed
			 and maintained by "Health Level Seven International" (HL7) which specifies a
			 library of templates and prescribes their use for a set of specific document
			 types for the purpose of electronic exchange of health care
			 information.
(6)
									"Eligible member" is the medicaid covered individual
			 who meets the diagnosis and service utilization criteria that enables them to
			 receive BHCC from a qualified behavioral health entity to which they have been
			 attributed.
(7)
									"Fast healthcare interoperability resources" (FHIR) is
			 a standard developed by HL7 for exchanging healthcare information
			 electronically.
(8)
									"Healthcare effectiveness data and information set"
			 (HEDIS) is a tool developed by the national center for quality care (NCQA) to
			 measure performance on dimensions of care and service.
(9)
									"Medication-assisted treatment" (MAT) is the combined
			 provision of behavioral therapy and medications for the treatment of substance
			 use disorders. All medications must be approved by the United States food and
			 drug administration (FDA) for the treatment of a substance use
			 disorder.
(10)
									"National quality forum" (NQF) refers to the
			 performance measures endorsed by the national quality forum.
(11)
									"Performance and
			 quality improvement" (PQI) refers to the standards developed by the council on
			 accreditation (COA) that measure effective quality improvement
			 plans.
(12)
									"Primary care practice" (PCP) is a practice led by
			 primary care practitioners who comprehensively manage the health needs of
			 individuals.
(13)
									"Qualified behavioral health entity" (QBHE) is the
			 participating entity which has attributed individuals and is responsible for
			 the BHCC activities.