MedicaidPrior AuthMedium impact
5160-1-31 - Prior authorization [except for services provided through medicaid contracting managed care plans (MCPs)]. (Rescind/Final File)
Ohio Medicaid·OH·Prior Authorization
Effective date
Jun 30, 2024
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has rescinded Rule 5160-1-31 regarding prior authorization requirements, except for services provided through Medicaid contracting managed care plans (MCPs). This represents a simplification of prior authorization rules for traditional Ohio Medicaid, while MCPs maintain their own authorization processes.
Action Required
By June 30, 2024: Billing team must verify current prior authorization requirements for Ohio Medicaid patients. For traditional Ohio Medicaid (non-MCP): Review which services no longer require prior auth under the rescinded rule. For Medicaid MCP patients: Continue following individual managed care plan authorization requirements. Update billing workflows to distinguish between traditional Medicaid and MCP authorization processes.