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Section 5167.102 - [Repealed]
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 5167.121 - [Renumbered]
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 5167.15 - Chiropractic services
Section 5167.16 - [Effective Until 1/1/2025] Home visits and cognitive behavioral therapy
Section 5167.16 - [Effective 1/1/2025] 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Section 5167.172 - [Repealed]
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Section 5167.25 - [Repealed]
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 5167.35 - Meaningful employment of Medicaid recipients
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