2020 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.