Amended Substitute House Bill 93 of the 129th General Assembly requires state agencies to establish and modify laws regarding the prevention of prescription drug abuse. ODJFS is required to adopt rules implementing a Coordinated Services Program (CSP) for Medicaid consumers who have received prescription drugs at a frequency or in an amount that is not medically necessary. The Medicaid rules implemented the CSP earlier than the statute requires, and also permit ODJFS to assign Medicaid consumers to a single primary provider of physician services. The Bureau of State Hearings establishes Medicaid consumer hearing rights and ODJFS notice requirements as it relates to the CSP.
The effective date of the rules is January 1, 2012.
SHM 1000.
5101:6-2-37 "Notices of enrollment, continued enrollment, or provider change denial for the managed care plan controlled substances and member management program", is rescinded and part of this rule is incorporated into new rule 5101:6-2-40, "State Hearings: Coordinated services program state hearing and notice requirements."
5101:6-2-40 "State Hearings: Coordinated services program state hearing and notice requirements", is rescinded and made new to introduce the hearing process for Medicaid's CSP. This rule includes hearing and notices rights associated with proposed enrollment into the CSP, continued enrollment into the CSP, and denial of a designated provider change. This rule also replaces part of rule 5101:6-2-37 of the Administrative Code.
5101:6-3-01 "Grounds for requesting a state hearing", is amended and describes the grounds for individuals requesting a state hearing, as it relates to public and medical assistance programs. Changes are limited to strikeouts and name changes reflecting Medicaid's CSP.
5101:6-4-01 "Continuation of benefits when a state hearing is requested", is amended and describes when a continuation of public assistance or medical assistance benefits occurs during the state hearing process. Changes are limited to strikeouts and name changes reflecting Medicaid's CSP.
5101:6-6-01 "Scheduling and attendance", is amended and describes the state hearing scheduling and attendance process for consumers applying or receiving public assistance or medical assistance benefits. Changes are limited to strikeouts and name changes for Medicaid's CSP. The County Departments of Job and Family Services shall continue to use the form JFS 04068 "State Hearing Compliance" (rev. 05/2001) to certify compliance is achieved.
5101:6-7-03 "Implementation of the hearing decision," is amended and describes how a state hearing decision as it relates to public assistance or medical assistance benefit occurs during the state hearing process. Changes are limited to strikeouts and name changes of Medicaid's CSP. ODJFS will continue to use the form JFS 04002 "State Hearing Scheduling Notice" (rev. 09/2002) for scheduling consumer appointments.
FORMS:
JFS 01704"Notice of Proposed Enrollment in the Controlled Substances and Member Management (CSMM) Program by Your Managed Care Plan", effective 07/2009, is obsolete and replaced by JFS 01704 "Notice of Proposed Enrollment in the Coordinated Services Program (CSP) by ODJFS or by Your Managed Care Plan (MCP)", effective 07/2011.
JFS 01705"Notice of Continued Enrollment in the Controlled Substances and Member Management (CSMM) Program by Your Managed Care Plan", effective 07/2009, is obsolete and replaced by JFS 01705 "Notice of Continued Enrollment in the Coordinated Services (CSP) by ODJFS or by Your Managed Care Plan (MCP)," effective 07/2011.
JFS 01706"Notice of Denial of Designated Provider Change in the Controlled Substances and Member Management (CSMM) Program by Your Managed Care Plan," effective 07/2009, is obsolete and replaced by JFS 01706 "Notice of Denial of Designated Provider or Pharmacy Change in the Coordinated Services (Program) by ODJFS or by your Managed Care Plan (MCP)," effective 07/2011.
JFS 04028"Notice of Proposed Enrollment in the Primary Alternative Care and Treatment Program", effective 04/2003, is rescinded and replaced by JFS 01704"Notice of Proposed Enrollment in the Coordinated Services Program (CSP) by ODJFS or by Your Managed Care Plan (MCP)", effective 07/2011.
JFS 04029"Notice of Denial of Designated Provider Change for Primary Alternative Care and Treatment (PACT) Program", effective 03/2003, is obsolete and replaced by JFS 01706"Notice of Denial of Designated Provider or Pharmacy Change in the Coordinated Services (Program) by ODJFS or by your Managed Care Plan (MCP)," effective 07/2011.
JFS 04030"Notice of Proposed Continued Enrollment Primary Alternative Care and Treatment (PACT) Program", effective 04/2003, is rescinded and replaced by JFS 01705"Notice of Continued Enrollment in the Coordinated Services (CSP) by ODJFS or by Your Managed Care Plan (MCP)," effective 07/2011.
SHM Instructions:
| Location | Remove | Replace |
|---|
| SHM 1000. | 5101:6‑2‑37 (effective 8/1/10) | N/A |
| | 5101:6‑2‑40 (effective 9/1/08) | 5101:6‑2‑40 (effective 1/1/2012) |
| | 5101:6‑3‑01 (effective 8/1/10) | 5101:6‑3‑01 (effective 1/1/2012) |
| | 5101:6‑4‑01 (effective 8/1/10) | 5101:6‑4‑01 (effective 1/1/2012) |
| | 5101:6‑6‑01 (effective 9/1/08) | 5101:6‑6‑01 (effective 1/1/2012) |
| | 5101:6‑7‑03 (effective 9/1/08) | 5101:6‑7‑03 (effective 1/1/2012) |
| | | |
| Forms | JFS 01704 (effective 07/2009) | JFS 01704 (effective 07/2011)
|
| | JFS 01705 (effective 07/2009) | JFS 01705 (effective 07/2011)
|
| | JFS 01706 (effective 07/2009) | JFS 01706 (effective 07/2011)
|
| | JFS 04028 (effective 04/2003) | N/A |
| | JFS 04029 (effective 03/2003) | N/A |
| | JFS 04030 (effective 04/2003) | N/A |
This information is also available on the Internet and may be accessed at:
ODJFS Electronic Manuals
http://emanuals.jfs.ohio.gov/
InnerWeb Calendar:
http://www.odjfs.state.oh.us/lpc/calendar/staff/
Internet Calendar:
http://www.odjfs.state.oh.us/lpc/calendar/