Ohio Admin. Code 5160-59-01.1 - OhioRISE: application of general managed care rules

(A) The Ohio resilience through integrated systems and excellence (OhioRISE) plan has to adhere to all of the requirements applicable to managed care organizations (MCOs) or managed care entities (MCEs) in the following rules:

(1) Rule 5160-26-05 of the Administrative Code with the exception of paragraphs (B)(4), (B)(5), (D)(21), (D)(25), and (D)(26);

(2) Rule 5160-26-05.1 of the Administrative Code with the exception of paragraph (B)(1);

(3) Rule 5160-26-06 of the Administrative Code;

(4) Rule 5160-26-08.3 of the Administrative Code with the exception of paragraphs (A)(19) and (A)(25);

(5) Rule 5160-26-08.4 of the Administrative Code;

(6) Rule 5160-26-09.1 of the Administrative Code;

(7) Rule 5160-26-10 of the Administrative Code with the exceptions of paragraphs (B)(2)(c), (B)(2)(d), and (B)(2)(e); and

(8) Rule 5160-26-11 of the Administrative Code.

(B) For all rules listed in paragraph (A) of this rule, the following provisions apply to the OhioRISE program described in Chapter 5160-59 of the Administrative Code:

(1) All references to rule 5160-26-01 of the Administrative Code are replaced by references to rule 5160-59-01 of the Administrative Code.

(2) All references to rules 5160-26-02 and 5160-26-02.1 of the Administrative Code are replaced by references to rule 5160-59-02 of the Administrative Code.

(3) All references to rule 5160-26-03 of the Administrative Code are replaced by references to rule 5160-59-03 of the Administrative Code.

(4) All references to rule 5160-26-03.1 of the Administrative Code are replaced by references to rule 5160-59-03.1 of the Administrative Code.

(C) The following rules in Chapter 5160-26 of the Administrative Code do not apply to OhioRISE:

(1) Rule 5160-26-02 of the Administrative Code;

(2) Rule 5160-26-02.1 of the Administrative Code;

(3) Rule 5160-26-03 of the Administrative Code;

(4) Rule 5160-26-03.1 of the Administrative Code.

Notes

Ohio Admin. Code 5160-59-01.1

Effective: 7/1/2022
Five Year Review (FYR) Dates: 07/01/2027
Promulgated Under: 119.03
Statutory Authority: 5167.02, 5162.02
Rule Amplifies: 5162.03, 5167.10