As used in this chapter:
(A)"340B grantee" means an entity described in section 340B(a)(4)(A)-
(K)of the "Public Health Service Act," 42 U.S.C. 256b(a)(4)(A)- (K)that is designated as an active (A)-
(K)entity under the health resources and services administration covered entity daily report, and includes any pharmacy under contract with the entity to dispense drugs on behalf of the entity.
(B)"Affiliated company" means an entity, including a third-party payer or specialty pharmacy, with common ownership, members of a board of directors, or managers, or that is a parent company, subsidiary company, jointly held company, or holding company with respect to the other entity.
(C)"Care management system" means the system established under section5167.03of the Revised Code.
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As used in this chapter:
(A) "340B grantee" means an entity described in section 340B(a)(4)(A)-(K) of the "Public Health Service Act," 42 U.S.C. 256b(a)(4)(A)-(K) that is designated as an active (A)-(K) entity under the health resources and services administration covered entity daily report, and includes any pharmacy under contract with the entity to dispense drugs on behalf of the entity.
(B) "Affiliated company" means an entity, including a third-party payer or specialty pharmacy, with common ownership, members of a board of directors, or managers, or that is a parent company, subsidiary company, jointly held company, or holding company with respect to the other entity.
(C) "Care management system" means the system established under section5167.03of the Revised Code.
(D) "Controlled substance" has the same meaning as in section3719.01of the Revised Code.
(E) "Dual eligible individual" has the same meaning as in section5160.01of the Revised Code.
(F) "Emergency services" has the same meaning as in the "Social Security Act," section 1932(b)(2), 42 U.S.C. 1396u-2(b)(2).
(G) "Enrollee" means a medicaid recipient who participates in the care management system and enrolls in a medicaid MCO plan.
(H) "ICDS participant" and "integrated care delivery system" have the same meanings as in section5164.01of the Revised Code.
(I) "ICDS successor program" means a fully integrated dual eligible special needs plan established in accordance with 42 C.F.R. 422.107, that the department of medicaid utilizes as a replacement for the integrated care delivery system.
(J) "Medicaid managed care organization" means a managed care organization under contract with the department of medicaid pursuant to section5167.10of the Revised Code.
(K) "Medicaid MCO plan" means a plan that a medicaid managed care organization, pursuant to its contract with the department of medicaid under section5167.10of the Revised Code, makes available to medicaid recipients participating in the care management system.
(L) "Medicaid waiver component" has the same meaning as in section5166.01of the Revised Code.
(M) "Network provider" has the same meaning as in 42 C.F.R. 438.2.
(N) "Nursing facility services" has the same meaning as in section5165.01of the Revised Code.
(O) "Part B drug" means a drug or biological described in section 1842(o)(1)(C) of the "Social Security Act," 42 U.S.C. 1395u(o)(1)(C).
(P) "Pharmacy benefit manager" has the same meaning as in section3959.01of the Revised Code.
(Q) "Practice of pharmacy" has the same meaning as in section4729.01of the Revised Code.
(R) "Prescribed drug" has the same meaning as in section5164.01of the Revised Code.
(S) "Prior authorization requirement" has the same meaning as in section5160.34of the Revised Code.
(T) "Provider" means any person or government entity that furnishes services to a medicaid recipient enrolled in a medicaid MCO plan, regardless of whether the person or entity has a provider agreement.
(U) "Provider agreement" has the same meaning as in section5164.01of the Revised Code.
(V) "State pharmacy benefit manager" means the pharmacy benefit manager selected by and under contract with the medicaid director under section5167.24of the Revised Code.
(W) "Third-party administrator" means any person who adjusts or settles claims on behalf of an insuring entity in connection with life, dental, health, prescription drugs, or disability insurance or self-insurance programs and includes a pharmacy benefit manager.
Last updated August 13, 2025 at 11:16 AM