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To amend sections 5164.01, 5167.01, and 5167.03 and | 1 |
to enact sections 5164.151, 5167.15, and 5167.151 | 2 |
of the Revised Code regarding Medicaid-covered | 3 |
community behavioral health services. | 4 |
Section 1. That sections 5164.01, 5167.01, and 5167.03 be | 5 |
amended and sections 5164.151, 5167.15, and 5167.151 of the | 6 |
Revised Code be enacted to read as follows: | 7 |
Sec. 5164.01. As used in this chapter: | 8 |
(A) "Community behavioral health services" means the | 9 |
following: | 10 |
(1) Community alcohol and drug addiction services provided by | 11 |
community addiction services providers certified by the department | 12 |
of mental health and addiction services under section 5119.36 of | 13 |
the Revised Code; | 14 |
(2) Community mental health services provided by community | 15 |
mental health services providers certified by the department of | 16 |
mental health and addiction services under section 5119.36 of the | 17 |
Revised Code. | 18 |
(B) "Early and periodic screening, diagnostic, and treatment | 19 |
services" has the same meaning as in the "Social Security Act," | 20 |
section 1905(r), 42 U.S.C. 1396d(r). | 21 |
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as in section 5160.01 of the Revised Code. | 23 |
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program that provides early and periodic screening, diagnostic, | 25 |
and treatment services. | 26 |
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component" has the same meaning as in section 5166.01 of the | 28 |
Revised Code. | 29 |
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of the Revised Code. | 31 |
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who participates in the integrated care delivery system. | 33 |
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of the Revised Code. | 35 |
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demonstration project authorized by section 5164.91 of the Revised | 37 |
Code. | 38 |
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and items that must be covered by the medicaid state plan as a | 40 |
condition of the state receiving federal financial participation | 41 |
for the medicaid program. | 42 |
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meaning as in section 5167.01 of the Revised Code. | 44 |
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entity with a valid provider agreement to provide medicaid | 46 |
services to medicaid recipients. To the extent appropriate in the | 47 |
context, "medicaid provider" includes a person or government | 48 |
entity applying for a provider agreement, a former medicaid | 49 |
provider, or both. | 50 |
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following: | 52 |
(1) Mandatory services; | 53 |
(2) Optional services that the medicaid program covers. | 54 |
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5165.01 of the Revised Code. | 56 |
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items that may be covered by the medicaid state plan or a federal | 58 |
medicaid waiver and for which the medicaid program receives | 59 |
federal financial participation. | 60 |
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440.120. | 62 |
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of the following apply: | 64 |
(1) It is between a medicaid provider and the department of | 65 |
medicaid; | 66 |
(2) It provides for the medicaid provider to provide medicaid | 67 |
services to medicaid recipients; | 68 |
(3) It complies with 42 C.F.R. 431.107(b). | 69 |
| 70 |
meaning as in section 4729.01 of the Revised Code. | 71 |
Sec. 5164.151. The medicaid program shall not limit the | 72 |
number of hours that, or visits at which, medicaid recipients who | 73 |
are eligible for community behavioral heath services covered by | 74 |
the medicaid program may receive the services. | 75 |
Sec. 5167.01. As used in this chapter: | 76 |
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the same meaning as in section 5164.01 of the Revised Code. | 78 |
"Controlled substance" has the same meaning as in section | 79 |
3719.01 of the Revised Code. | 80 |
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section 5160.01 of the Revised Code. | 82 |
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"Social Security Act," section 1932(b)(2), 42 U.S.C. | 84 |
1396u-2(b)(2). | 85 |
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component" has the same meaning as in section 5166.01 of the | 87 |
Revised Code. | 88 |
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organization under contract with the department of medicaid | 90 |
pursuant to section 5167.10 of the Revised Code. | 91 |
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section 5166.01 of the Revised Code. | 93 |
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5165.01 of the Revised Code. | 95 |
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5164.01 of the Revised Code. | 97 |
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furnishes services to a medicaid recipient enrolled in a medicaid | 99 |
managed care organization, regardless of whether the person or | 100 |
entity has a provider agreement. | 101 |
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5164.01 of the Revised Code. | 103 |
Sec. 5167.03. (A) As part of the medicaid program, the | 104 |
department of medicaid shall establish a care management system. | 105 |
(B) The department shall implement the care management system | 106 |
in some or all counties and shall designate the medicaid | 107 |
recipients who are required or permitted to participate in the | 108 |
system. In the department's implementation of the system and | 109 |
designation of participants, | 110 |
(1) In the case of individuals who receive medicaid on the | 111 |
basis of being included in the category identified by the | 112 |
department as covered families and children, the department shall | 113 |
implement the care management system in all counties. All | 114 |
individuals included in the category shall be designated for | 115 |
participation, except for individuals included in one or more of | 116 |
the medicaid recipient groups specified in 42 C.F.R. 438.50(d). | 117 |
The department shall ensure that all participants are enrolled in | 118 |
medicaid managed care organizations that are health insuring | 119 |
corporations. | 120 |
(2) In the case of individuals who receive medicaid on the | 121 |
basis of being aged, blind, or disabled, the department shall | 122 |
implement the care management system in all counties. Except as | 123 |
provided in division (C) of this section, all individuals included | 124 |
in the category shall be designated for participation. The | 125 |
department shall ensure that all participants are enrolled in | 126 |
medicaid managed care organizations that are health insuring | 127 |
corporations. | 128 |
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(C)(1) In designating participants who receive medicaid on | 136 |
the basis of being aged, blind, or disabled, the department shall | 137 |
not include any of the following, except as provided under | 138 |
division (C)(2) of this section: | 139 |
(a) Individuals who are under twenty-one years of age; | 140 |
(b) Individuals who are institutionalized; | 141 |
(c) Individuals who become eligible for medicaid by spending | 142 |
down their income or resources to a level that meets the medicaid | 143 |
program's financial eligibility requirements; | 144 |
(d) Dual eligible individuals; | 145 |
(e) Individuals to the extent that they are receiving | 146 |
medicaid services through a medicaid waiver component. | 147 |
(2) The department may designate any of the following | 148 |
individuals who receive medicaid on the basis of being aged, | 149 |
blind, or disabled as individuals who are permitted or required to | 150 |
participate in the care management system: | 151 |
(a) Individuals who are under twenty-one years of age; | 152 |
(b) Individuals who reside in a nursing facility; | 153 |
(c) Individuals who, as an alternative to receiving nursing | 154 |
facility services, are participating in a home and community-based | 155 |
services medicaid waiver component; | 156 |
(d) Dual eligible individuals. | 157 |
(D) Subject to division (B) of this section, the department | 158 |
may do both of the following under the care management system: | 159 |
(1) Require or permit participants in the system to obtain | 160 |
health care services from providers designated by the department; | 161 |
(2) Require or permit participants in the system to obtain | 162 |
health care services through medicaid managed care organizations. | 163 |
Sec. 5167.15. When contracting under section 5167.10 of the | 164 |
Revised Code with a managed care organization that is a health | 165 |
insuring corporation, the department of medicaid may authorize the | 166 |
health insuring corporation to provide coverage of the following | 167 |
community behavioral health services for medicaid recipients | 168 |
enrolled in the health insuring corporation: | 169 |
(A) Ambulatory detoxification; | 170 |
(B) Community psychiatric supportive treatment; | 171 |
(C) Diagnostic assessment; | 172 |
(D) Health home comprehensive care coordination; | 173 |
(E) Individual and group counseling; | 174 |
(F) Inpatient psychiatric care in freestanding psychiatric | 175 |
hospitals; | 176 |
(G) Intensive outpatient treatment for alcohol and drug | 177 |
addiction; | 178 |
(H) Methadone administration; | 179 |
(I) Partial hospitalization; | 180 |
(J) Pharmacological management. | 181 |
Sec. 5167.151. A medicaid managed care organization that | 182 |
provides coverage of community behavioral health services under | 183 |
section 5167.15 of the Revised Code shall not establish any limits | 184 |
on the number of hours that, or visits at which, medicaid | 185 |
recipients who are eligible for the services may receive the | 186 |
services. | 187 |
Section 2. That existing sections 5164.01, 5167.01, and | 188 |
5167.03 of the Revised Code are hereby repealed. | 189 |