MedicaidAdministrativeMedium impact
5160-26-03.1 - Managed care: primary care and utilization management. (Amend/Final File)
Ohio Medicaid·OH·Managed Care
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Ohio Medicaid updated Rule 5160-26-03.1 regarding managed care primary care and utilization management, effective January 1, 2026. This is the most recent amendment to Ohio Medicaid managed care requirements that will affect how primary care services and utilization management are handled.
Action Required
Before January 1, 2026: Billing team should review the complete rule text at the Ohio Register website to understand specific changes to Ohio Medicaid managed care requirements. Update billing procedures and workflows for Ohio Medicaid managed care patients according to the new utilization management requirements.