MedicaidAdministrativeMedium impact
5160-58-03.1 - MyCare Ohio plans: primary care and utilization management. (Amend/Final File)
Ohio Medicaid·OH · Family Medicine, Internal Medicine, General Practice +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has finalized amendments to Rule 5160-58-03.1 governing MyCare Ohio plans' primary care and utilization management requirements. This policy affects how primary care services are managed and authorized for MyCare Ohio Medicaid managed care plan members.
Action Required
By January 1, 2026: Billing team should review updated MyCare Ohio utilization management requirements and primary care protocols. Contact MyCare Ohio plans directly to obtain specific changes to prior authorization requirements, referral processes, or documentation standards. Update billing workflows and staff training materials based on the revised rule requirements.