2006 Ohio Revised Code - [5111.16.1] 5111.161.Care management working group.

[§ 5111.16.1] § 5111.161. Care management working group.
 

(A)  There is hereby created the medicaid care management working group, consisting of the following members: 

(1) Three individuals representing medicaid health insuring corporations, as defined in section 5111.176 [5111.17.6] of the Revised Code, one appointed by the president of the senate, one appointed by the speaker of the house of representatives, and one appointed by the governor; 

(2) One individual representing programs that provide enhanced care management services, appointed by the governor; 

(3) Four individuals representing health care professional and trade associations, appointed as follows: 

(a) One representative of the American academy of pediatrics, appointed by the president of the senate; 

(b) One representative of the American academy of family physicians, appointed by the speaker of the house of representatives; 

(c) One representative of the Ohio state medical association, appointed by the president of the senate; 

(d) One representative of the Ohio hospital association, appointed by the speaker of the house of representatives. 

(4) One individual representing behavioral health professional and trade associations, appointed by the speaker of the house of representatives; 

(5) Two individuals representing consumer advocates, one appointed by the president of the senate and one appointed by the speaker of the house of representatives; 

(6) One individual representing county departments of job and family services, appointed by the president of the senate; 

(7) Three individuals representing the business community, one appointed by the president of the senate, one appointed by the speaker of the house of representatives, and one appointed by the governor; 

(8) One individual representing providers of services that the state has the option of providing under federal medicaid law. The individual shall be appointed by the president of the senate from among one nomination each from the Ohio optometric association, the Ohio dental association, and the Ohio podiatric medical association. 

(9) The director of job and family services or the director's designee; 

(10) The director of health or the director's designee; 

(11) The director of aging or the director's designee. 

(B)  The members of the working group shall serve at the pleasure of their appointing authorities. Vacancies shall be filled in the manner provided for original appointments. 

(C)  The working group shall develop guidelines that the department of job and family services may consider when entering into contracts under section 5111.17 of the Revised Code with managed care organizations for purposes of the care management system established under section 5111.16 of the Revised Code. The working group shall consult regularly with the departments of insurance, alcohol and drug addiction services, mental health, and mental retardation and developmental disabilities and the rehabilitation services commission. 
 

In developing the guidelines, the working group shall do all of the following: 

(1) Examine the best practice standards used in managed care programs and other health care and related systems to maximize patient and provider satisfaction, maintain quality of care, and obtain cost-effectiveness; 

(2) Consider the most effective means of facilitating the expansion of the care management system and increasing consistency within the system; 

(3) Make recommendations for coordinating the regulatory relationships involved in the medicaid care management system; 

(4) Make recommendations for improving the resolution of contracting issues among the providers involved in the care management system; 

(5) Make recommendations that the department may consider when developing and implementing the financial incentive program under division (B) of section 5111.17 of the Revised Code to improve and reward positive health outcomes through managed care contracts. In making these recommendations, the working group shall include all of the following: 

(a) Standards and procedures by which care management contractors may receive financial incentives for positive health outcomes measured on an individual basis; 

(b) Specific measures of positive health outcomes, particularly among individuals with high-risk health conditions; 

(c) Criteria for determining what constitutes a completed health outcome; 

(d) Methods of funding the program without requiring an increase in appropriations. 

(D)  The working group shall prepare an annual report on its activities and shall submit the report to the president of the senate, speaker of the house of representatives, and governor. The report shall include any findings and recommendations the working group considers relevant to its duties. The working group shall complete an initial report not later than December 31, 2005. Each year thereafter, the working group shall complete its annual report by the last day of December. 
 

HISTORY: 151 v H 66, § 101.01, eff. 6-30-05; 151 v H 530, § 101.01, eff. 6-30-06.
 

The effective date is set by § 812.03 of 151 v H 530. 

The effective date is set by § 612.12 of 151 v H 66. 

 

Effect of Amendments

151 v H 530, effective June 30, 2006, inserted (A)(8) and redesignated the remaining subdivisions accordingly.