Ohio Code 5167.16 – Home visits and cognitive behavioral therapy
(A) As used in this section:
Terms Used In Ohio Code 5167.16
- Child: includes child by adoption. See Ohio Code 1.59
- Medicaid managed care organization: means a managed care organization under contract with the department of medicaid pursuant to section 5167. See Ohio Code 5167.01
- Provider: means any person or government entity that furnishes services to a medicaid recipient enrolled in a medicaid MCO plan, regardless of whether the person or entity has a provider agreement. See Ohio Code 5167.01
(1) “Help me grow program” means the program established by the department of health pursuant to section 3701.61 of the Revised Code.
(2) “Targeted case management” has the same meaning as in 42 C.F.R. § 440.169(b).
(B) A medicaid managed care organization shall provide to a medicaid recipient who meets the criteria in division (C) of this section, or arrange for such recipient to receive, both of the following types of services:
(1) Home visits, which shall include depression screenings, for which federal financial participation is available under the targeted case management benefit;
(2) Cognitive behavioral therapy, provided by a community mental health services provider, that is determined to be medically necessary through a depression screening conducted as part of a home visit.
(C) A medicaid recipient qualifies to receive the services specified in division (B) of this section if the medicaid recipient is enrolled in the help me grow program, enrolled in the medicaid managed care organization providing or arranging for the services, and is either pregnant or the birth mother of a child under five years of age.
(D) If requested by a medicaid recipient eligible for the cognitive behavioral therapy covered under division (B)(2) of this section, the therapy shall be provided in the recipient’s home. The medicaid managed care organization shall inform the medicaid recipient of the right to make the request and how to make it.
Last updated September 29, 2023 at 2:54 PM