Common use of Information Required for MCP Websites Clause in Contracts

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email process is an acceptable substitute if the website includes the MCP’s email address for such submissions). b. The MCP provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as a iv. The MCP’s policies and procedures for all providers (in-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email process is an acceptable substitute if the website includes the MCP’s email address for such submissions). b. The MCP provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters, and announcements. iv. The MCP’s policies and procedures for all providers (inout-of-network and out- of-network) providers to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email e-mail process is an acceptable substitute if the website includes the MCP’s email e-mail address for such submissions). b. The MCP provider website shall also include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as a iv. The MCP’s policies and procedures for all providers (inout-of-network and out- of-network) providers to seek payment of claims for emergency, post-stabilization, stabilization and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link The MCP’s PDL, including an explanation of the list and identification of any preferred drugs that require PA, the MCP’s list of drugs that require PA, including an explanation of the list, identification of first line drugs for drugs that require PA for step therapy, how to initiate a PA, and the MCP’s policy for coverage of generic versus brand name drugs. The MCP shall publish a notice of changes to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included MCP’s PDL 30 calendar days in the UPDLadvance. vii. A The MCP shall publish a notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation The MCP shall provide documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. InThe MCP shall provide prescribers with in-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All The MCP shall provide all Healthchek information as specified in this appendix. xi. Prominent, easily understood ODM may require the MCP to include additional information on its the provider website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting)as needed. xii. The MCP shall publish the requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. On-line Provider Directory - MCPs must have an internet-based provider directory available in the same format as their ODJFS-approved provider directory, that allows members to electronically search for the MCP panel providers based on name, provider type, geographic proximity, and population (as specified in Appendix H). MCP provider directories must include all MCP-contracted providers [except as specified by ODJFS] as well as certain Appendix C Covered Families and Children (CFC) population Page 24 ODJFS non-contracted providers. b. On-line Member Website - MCPs must have a secure internet-based website which is regularly updated to include the most current ODJFS approved materials. The website at a minimum must include: (1) a list of the counties that are covered in their service area; (2) the ODJFS-approved MCP shall member handbook, recent newsletters/announcements, MCP contact information including member services hours and closures; (3) the MCP provider directory as referenced in section 36(a) of this appendix; (4) the MCP's current preferred drug list (PDL), including an explanation of the list, which drugs require prior authorization (PA), and the PA process; (5) the MCP's current list of drugs covered only with PA, the PA process, and the MCP's policy for covering generic for brand-name drugs; and (6) the ability for members to submit questions/comments/grievances/appeals/etc. and receive a response (members must be given the option of a return e-mail or phone call) within one working day of receipt. MCPs must ensure that all member materials designated specifically for CFC and/or ABD consumers (i.e. the MCP member handbook) are clearly labeled as such. The MCP's member website cannot be used as the only means to notify members of new and/or revised MCP information (e.g., change in holiday closures, change in additional benefits, revisions to approved member materials etc.). ODJFS may require MCPs to include additional information on the member website, as needed. c. On-line Provider Website - MCPs must have a secure internet-based website for contracting providers through which providers can where they will be able to confirm a consumer’s 's MCP enrollment and through which this website (or through e-mail process) allow providers can to electronically submit and receive responses to prior authorization requests (an email process is an acceptable substitute if the requests. This website includes the MCP’s email address for such submissions). b. The MCP provider website shall must also include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing (1) a list of the counties the MCP serves unless the MCP serves the entire state that are covered in which case the MCP may indicate it services the entire state.their service area; iii. The MCP’s provider manual including (2) the MCP’s claims submission process, as well as a iv. The MCP’s policies and procedures for all providers 's provider manual;(in-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email process is an acceptable substitute if the website includes the MCP’s email address for such submissions). b. The MCP provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters, and announcements. iv. The MCP’s policies and procedures for all providers (in-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesteronexxxxx://xxx.xxxx.xxx/prematurity-prevention?adlt=strict) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-MCP- contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email process is an acceptable substitute if the website includes the MCP’s email address for such submissions). b. The MCP provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters, and announcements. iv. The MCP’s policies and procedures for all providers (in-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesteronexxxxx://xxx.xxxx.xxx/prematurity-prevention?adlt=strict)) and nd the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-MCP- contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The On-line Provider Directory – MCPs must have an internet-based provider directory available in the same format as their ODJFS-approved provider directory, that allows members to electronically search for the MCP shall panel providers based on name, provider type, geographic proximity, and population (as specified in Appendix H). MCP provider directories must include all MCP-contracted providers [except as specified by ODJFS] as well as certain ODJFS non-contracted providers. b. On-line Member Website – MCPs must have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses is regularly updated to prior authorization requests (an email process is an acceptable substitute if include the most current ODJFS approved materials. The website includes the MCP’s email address for such submissions). b. The MCP provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing minimum must include: (1) a list of the counties that are covered Appendix C Covered Families and Children (CFC) population Page 24 in their service area; (2) the ODJFS-approved MCP member handbook, recent newsletters/announcements, MCP contact information including member services hours and closures; (3) the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as a iv. The MCP’s policies and procedures for all providers (in-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in section 36(a) of this appendix and Appendix H. vi. A link to appendix; (4) the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate MCP’s current preferred drug list (PDL), including an explanation of the list, which drugs require prior authorization (PA), and the PA process; (5) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s current list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changescovered only with PA, the MCP shall notify providersPA process, via email or standard mail, and the specific location of prior authorization change information on MCP’s policy for covering generic for brand-name drugs; and (6) the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website ability for members to submit questions/comments/ grievances/appeals/etc. and providers regarding receive a response (members must be given the optimization option of pregnancy outcomesa return e-mail or phone call) within one working day of receipt. This shall include information MCPs must ensure that all member materials designated specifically for providers, trusted messengers CFC and/or ABD consumers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, i.e. the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiiimember handbook) are clearly labeled as such. The MCP’s specific standards for specialty pharmacies member website cannot be used as the only means to become network providersnotify members of new and/or revised MCP information (e.g., change in holiday closures, change in additional benefits, revisions to approved member materials etc. xiv). Any ODJFS may require MCPs to include additional information that ODM may require the MCP to include on the provider website member website, as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email e-mail process is an acceptable substitute if the website includes the MCP’s email e-mail address for such submissions). b. The MCP provider website shall also include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues.; ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state.; iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters and announcements; iv. The MCP’s policies and procedures for all providers (inout-of-network and out- of-network) providers to seek payment of claims for emergency, post-stabilization, stabilization and any other services authorized by the MCP.; v. The MCP’s internet provider directory as referenced in this appendix Appendix and Appendix H.H; and vi. A link The MCP’s PDL, including an explanation of the list and identification of any preferred drugs that require PA, the MCP’s list of drugs that require PA, including an explanation of the list, identification of first line drugs for drugs that require PA for step therapy, how to initiate a PA, and the MCP’s policy for coverage of generic versus brand name drugs. The MCP shall publish 30 days in advance a notice of changes to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (MCP’s PDL) for any drugs not included in the UPDL. vii. A The MCP shall publish 30 days in advance a notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advancewebsite. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation The MCP shall provide documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. InThe MCP shall provide prescribers with in-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All The MCP shall provide all Healthchek information as specified in this appendixAppendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include additional information on the provider website as needed.

Information Required for MCP Websites. a. On-line Provider Directory - MCPs must have an internet-based provider directory available in the same format as their ODJFS-approved provider directory, that allows members to electronically search for the MCP panel providers based on name. provider type. geographic proximity, and population (as specified in Appendix H). MCP provider directories must include all MCP-contracted providers [except as specified by ODJFS] as well as certain ODJFS non-contracted providers. b. On-line Member Website - MCPs must have a secure internet-based website which is regularly updated to include the most current ODJFS approved materials. The website at a minimum must include: (1) a list of the counties that are covered in their service area; (2) the ODJFS-approved MCP shall member handbook, recent newsletters/announcements, MCP contact information including member services hours and closures; (3) the MCP provider directory as referenced in section 36(a) of this appendix; (4) the MCP's current preferred drug list (PDL), including an explanation of the list. which drugs require prior authorization (PA), and the PA process; (5) the MCP's current list of drugs covered only with PA, the PA process, and the MCP's policy for covering generic for brand-name drugs; and (6) the ability for members to submit questions/comments/grievances/appeals/etc, and receive a response (members Appendix C must be given the option of a return e-mail or phone call) within one working day of receipt. MCPs must ensure that all member materials designated specifically for CFC and/or ABD consumers (i.e. the MCP member handbook) are clearly labeled as such. The MCP's member website cannot be used as the only means to notify members of new and/or revised MCP information (e.g., change in holiday closures, change in additional benefits, revisions to approved member materials etc.). ODJFS may require MCPs to include additional information on the member website, as needed. c. On-line Provider Website - MCPs must have a secure internet-based website for contracting providers through which providers can where they will be able to confirm a consumer’s 's MCP enrollment and through which this website (or through e-mail process) allow providers can to electronically submit and receive responses to prior authorization requests requests. This website must also include: (an email process is an acceptable substitute if 1) a list of the website includes counties that are covered in their service area; (2) the MCP’s email address for such submissions). b. The MCP 's provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. manual; (3) MCP contact information, including ; (4) a link to the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as a iv. The MCP’s policies and procedures for all providers (in's on-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet line provider directory as referenced in section 36(a) of this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List appendix; (UPDL5) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s 's current PDL list, including an explanation of the list, which drugs require PA, and the PA process; and (6) the MCP's current list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changescovered only with PA, the MCP shall notify providersPA process, via email or standard mail, and the specific location of prior authorization change MCP's policy for covering generic for brand-name drugs. MCPs must ensure that all member materials designated specifically for CFC and/or ABD consumers are clearly labeled as such. ODJFS may require MCPs to include additional information on the provider website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email e-mail process is an acceptable substitute if the website includes the MCP’s email e-mail address for such submissions). b. The MCP provider website shall also include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues.; ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state.; iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters and announcements; iv. The MCP’s policies and procedures for all providers (inout-of-network and out- of-network) providers to seek payment of claims for emergency, post-stabilization, stabilization and any other services authorized by the MCP.; v. The MCP’s internet provider directory as referenced in this appendix Appendix and Appendix H.H; and vi. A link The MCP’s PDL, including an explanation of the list and identification of any preferred drugs that require PA, the MCP’s list of drugs that require PA, including an explanation of the list, identification of first line drugs for drugs that require PA for step therapy, how to initiate a PA, and the MCP’s policy for coverage of generic versus brand name drugs. The MCP shall publish 30 days in advance a notice of changes to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (MCP’s PDL) for any drugs not included in the UPDL. vii. A The MCP shall publish 30 days in advance a notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advancewebsite. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation The MCP shall provide documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. InThe MCP shall provide prescribers with in-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. . x. All The MCP shall provide all Healthchek information as specified in this appendixAppendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email process is an acceptable substitute if the website includes the MCP’s email address for such submissions). b. The MCP provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters, and announcements. iv. The MCP’s policies and procedures for all providers (in-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall must have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email e-mail process is an acceptable substitute if the website includes the MCP’s email e-mail address for such submissions). b. The MCP provider website shall must also include, at a minimum, the following information which shall must be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues.; ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state.; iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters and announcements; iv. The MCP’s policies and procedures for all providers (inout-of-network and out- of-network) providers to seek payment of claims for emergency, post-stabilization, stabilization and any other services authorized by the MCP.; v. The MCP’s internet on-line provider directory as referenced in section 41.a. of this appendix and Appendix H.appendix; and vi. A link The MCP’s PDL, including an explanation of the list and identification of any preferred drugs that require PA, the MCP’s list of drugs that require PA, including an explanation of the list, identification of first line drugs for drugs that require PA for step therapy, how to initiate a PA, and the MCP’s policy for coverage of generic versus brand name drugs. The MCP must publish 30 days in advance a notice of changes to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (MCP’s PDL) for any drugs not included in the UPDL. vii. A MCPs must publish 30 days in advance a notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advancewebsite. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall MCPs must notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation MCPs must provide documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. InMCPs must provide prescribers with in-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All MCPs must provide all Healthchek information as specified in 25.b.i. of this appendixAppendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include additional information on the provider website as needed.

Information Required for MCP Websites. a. On-line ProviderDirectory– MCPs must have an internet-based provider directory available in the same format as their ODJFS-approved provider directory, that allows members to electronically search for the MCP panel providers based on name, provider type, geographic proximity, and population (as specified in Appendix H). MCP provider directories must include all MCP-contracted providers [except as specified by ODJFS] as well as certain ODJFS non-contracted providers. b. On-line Member Website – MCPs must have a secure internet-based website which is regularly updated to include the most current ODJFS approved materials. The website at a minimum must include: (1) a list of the counties that are covered in their service area; (2) the ODJFS-approved MCP shall member handbook, recent newsletters/announcements, MCP contact information including member services hours and closures; (3) the MCP provider directory as referenced in section 36(a) of this appendix; (4) the MCP’s current preferred drug list (PDL), including an explanation of the list, which drugs require prior authorization (PA), and the PA process; (5) the MCP’s current list of drugs covered only with PA, the PA process, and the MCP’s policy for covering generic for brand-name drugs; and (6) the ability for members to submit questions/comments/grievances/appeals/etc. and receive a response (members must be given the option of a return e-mail or phone call) within one working day of receipt. MCPs must ensure that all member materials designated specifically for CFC and/or ABD consumers (i.e. the MCP member handbook) are clearly labeled as such. The MCP’s member website cannot be used as the only means to notify members of new and/or revised MCP information (e.g., change in holiday closures, change in additional benefits, revisions to approved member materials etc.) ODJFS may require MCPs to include additional information on the member website, as needed. c. On-line Provider Website – MCPs must have a secure internet-based website for contracting providers through which providers can where they will be able to confirm a consumer’s MCP enrollment and through which this website (or through e-mail process) allow providers can to electronically submit and receive responses to prior authorization requests requests. This website must also include: (an email process is an acceptable substitute if 1) a list of the website includes counties that are covered in their service area; (2) the MCP’s email address for such submissions). b. The MCP provider website shall include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. manual;(3) MCP contact information, including ; (4) a link to the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as a iv. The MCP’s policies and procedures for all providers (inon-network and out- of-network) to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet line provider directory as referenced in section 37(a) of this appendix and Appendix H. vi. A link to the ODM Unified Preferred Drug List appendix; (UPDL5) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included in the UPDL. vii. A notice of changes to the MCP’s current PDL list, including an explanation of the list, which drugs require PA, and the PA process; (6) the MCP’s current list of drugs requiring covered only with PA, the PA or any other service or device requiring process, and the MCP’s policy for covering generic for brand-name drugs. MCPs must ensure that all provider materials designated specifically for CFC and/or ABD consumers (i.e. the MCP’s provider manual) are clearly labeled as such; and (7) information regarding the availability of expedited prior authorization via their website 30 calendar days requests, as well as the information that is required from that provider in advance. In addition, 30 calendar days prior order to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of substantiate an expedited prior authorization change request. ODJFS may require MCPs to include additional information on the provider website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. In-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All Healthchek information as specified in this appendix. xi. Prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email e-mail process is an acceptable substitute if the website includes the MCP’s email e-mail address for such submissions). b. The MCP provider website shall also include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters, and announcements. iv. The MCP’s policies and procedures for all providers (inout-of-network and out- of-network) providers to seek payment of claims for emergency, post-stabilization, and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link The MCP’s PDL, including an explanation of the list and identification of any preferred drugs that require PA, the MCP’s list of drugs that require PA, including an explanation of the list, identification of first line drugs for drugs that require PA for step therapy, how to initiate a PA, and the MCP’s policy for coverage of generic versus brand name drugs. The MCP shall publish a notice of changes to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included MCP’s PDL 30 calendar days in the UPDLadvance. vii. A The MCP shall publish a notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation The MCP shall provide documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. InThe MCP shall provide prescribers with in-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All The MCP shall provide all Healthchek information as specified in this appendix. xi. ProminentThe MCP shall provide prominent, easily understood information on its website for members and providers regarding the optimization of pregnancy outcomes. This shall information will include a link to the ODM PRAF 2.0 , as well as information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking treatment. xii. ODM may require the MCP to include additional information on the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx)provider website as needed. xiii. The MCP shall include a link to publish the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting). xii. The requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiiixiv. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.

Information Required for MCP Websites. a. The MCP shall have a secure internet-based website for contracting providers through which providers can confirm a consumer’s enrollment and through which providers can submit and receive responses to prior authorization requests (an email e-mail process is an acceptable substitute if the website includes the MCP’s email e-mail address for such submissions). b. The MCP provider website shall also include, at a minimum, the following information which shall be accessible to providers and the general public without any log-in restrictions: i. MCP contact information, including the MCP’s designated contact for provider issues. ii. A listing of the counties the MCP serves unless the MCP serves the entire state in which case the MCP may indicate it services the entire state. iii. The MCP’s provider manual including the MCP’s claims submission process, as well as aa list of services requiring PA, recent newsletters and announcements. iv. The MCP’s policies and procedures for all providers (inout-of-network and out- of-network) providers to seek payment of claims for emergency, post-stabilization, stabilization and any other services authorized by the MCP. v. The MCP’s internet provider directory as referenced in this appendix and Appendix H. vi. A link The MCP’s PDL, including an explanation of the list and identification of any preferred drugs that require PA, the MCP’s list of drugs that require PA, including an explanation of the list, identification of first line drugs for drugs that require PA for step therapy, how to initiate a PA, and the MCP’s policy for coverage of generic versus brand name drugs. The MCP shall publish a notice of changes to the ODM Unified Preferred Drug List (UPDL) at xxxxx://xxxxxxxx.xxxxxxxx.xxxx.xxx/drug-coverage. If applicable, the MCP may post a separate preferred drug list (PDL) for any drugs not included MCP’s PDL 30 calendar days in the UPDLadvance. vii. A The MCP shall publish a notice of changes to the MCP’s list of drugs requiring PA or any other service or device requiring prior authorization via their website 30 calendar days in advance. In addition, 30 calendar days prior to all PA requirement changes, the MCP shall notify providers, via email or standard mail, the specific location of prior authorization change information on the website, pursuant to ORC section 5160.34(B)(9-10). viii. Documentation The MCP shall provide documentation specifics for PA completion and details about Medicaid programs and their services requiring PA (e.g., drugs, devices) pursuant to ORC section 5160.34(B)(11). ix. InThe MCP shall provide prescribers with in-office access to their preferred drug and PA lists to prescribers via the availability of at least one hand-held software application. x. All The MCP shall provide all Healthchek information as specified in this appendix. xi. Prominent, easily understood ODM may require the MCP to include additional information on its the provider website for members and providers regarding the optimization of pregnancy outcomes. This shall include information for providers, trusted messengers (e.g., community health workers), and patients about the prevention of preterm birth through the use of progesterone treatment by linking to the Ohio Perinatal Quality Collaborative’s information about progesterone best practices at (xxxxx://xxxx.xxx/projects/progesterone) and the Ohio Department of Health’s progesterone-messaging toolkit located at (XxXxxxXxxXxxx.xxx). The MCP shall include a link to the official ODM notification of pregnancy and risk assessment form (PRAF 2.0) located at xxxxx://xxxxxxxx.xxxx.xxx/Provider/PRAF with a statement encouraging MCP-contracted providers to complete and submit the form to assist pregnant women in maintaining Medicaid eligibility and connecting to needed services and supports (e.g., home visiting)as needed. xii. The MCP shall publish the requirements and process for submitting an appeal related to Maximum Allowable Costs (MAC) for pharmacy providers on their website. Prior to implementation, the MCP shall submit its MAC appeal auditing process to ODM for approval to ensure a reasonable process is established for pharmacy providers. xiii. The MCP’s specific standards for specialty pharmacies to become network providers. xiv. Any additional information that ODM may require the MCP to include on the provider website as needed.