§ 5167.03 — Care management system

Ohio § 5167.03

• Jurisdiction: Ohio
• Title 51: Public Welfare
• Ch. 5167: Medicaid Managed Care

Text

(A) 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.

(B) 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 section5167.16of the Revised Code. Except as provided in section5166.406of the Revised Code, no medicaid recipient participating in the healthy Ohio program established under section5166.40of the Revised Code shall participate in the system.

(C) Except as otherwise provided in this section, 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. ICDS participants, or participants in the ICDS successor program, 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.

(D) the department may require or permit participants in the care management system to do either or both of the following:

(1) Obtain health care services from providers designated by the department;

(2) Enroll in a medicaid MCO plan.

Last updated August 13, 2025 at 11:16 AM

Legislative History

Effective: September 30, 2025 | Latest Legislation: House Bill 96 - 136th General Assembly