Ohio Medicaid

Medicaid Managed Care Request for Applications Applicant Library

January 11, 2012 

• General Information
  • List of Managed Care Organizations that Submitted Letters of Intent
  • Current and Past MCP Provider Agreements
  • Pharmacy Agreement
  • House Bill 153
    • Managed Care System (ORC 5111.16) 
    • Managed Care Exemption (Uncodified Language)
    • ACO (ORC 5111.161)
  • Ohio Medicaid Fee for Service Coverage Rules
  • Ohio Administrative Code Managed Care Rules
  • In-State Personnel Position Description Requirements
  • CMS Health Home Guidance Letter
  • Managed Care Plan (MCP) Member Selection and Enrollment Process 
  • Regional Map
  • Rural/Urban Designation 
  • Office of Ohio Health Plans Table of Organization
  • Ohio's Medicaid Quality Strategy

• Program Data
  • Rates
    • Certification of Calendar Year 2012 Rates (ABD)(CFC)
    • Data Book Calendar Year 2012 Rates (ABD)(CFC)
    • Calendar Year 2012 Rates (ABD)(CFC)
    • Rate Summary for Calendar Year 2012 (ABD)(CFC) 
  • Capitation Payment Schedule
  • Historical Eligibility and Utilization Data for Proposed Managed Care Population (pdf)
  • Historical Eligibility and Utilization Data for Proposed Managed Care Population (Excel)
  • Ohio Medicaid Reports
  • Medicaid Managed Care Program Reports (ABD)(CFC)
  • Consumer Assessment of Health Care Providers and Systems (CAHPS)

• ODJFS Methods and File Specifications
  • Methods and Specifications Descriptions
  • EDI Trading Partner, 820, and 834 Companion Guides
  • Early and Periodic Screening, Dianosis, and Treatment (EPSDT)
    • County Reporting File
    • MCP Dental File
  • TPL Resource File Specifications
  • Historical Fee for Service Prior Authorization File Specifications
  • Historical Fee for Service Utilization File Specifications
  • Delivery Payment Audit Methodology
  • Consumer Contact Record
  • CHIPRA Methods for SFY 2013
  • Care Management Program Measures for SFY 2013

• Performance Improvement Project (PIP)
  • Comprehensive Diabetes Care (CDC) PIP Methodology
  • EPSDT Collaborative PIP Study Methodology
  • Non-clinical PIP for Members with Special Health Care Needs (MSHCN)
  • PIP Summary Completion Form
  • PIP Validation Tool
  • PIPs Scoring Methodology

•  Fillable Application Forms
  • Appendix A
  • Appendix B
  • Appendix C
  • Appendix D (Updated 2/24/2012)
  • Appendix E (Updated 2/24/2012)

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