Coordinated Services Program (CSP) Sample Clauses

Coordinated Services Program (CSP). The MCP shall develop and submit for prior approval a CSP as defined in OAC rule 5160-20-01 to address the utilization or pattern of receiving medications at a frequency or in an amount that exceeds medical necessity. 1. The MCP shall, at a minimum, issue a notice of enrollment in CSP to members whose pattern of utilization, of controlled substances, exceeds medical necessity and follow all provisions of OAC rule 5160-20-01 for initial and continued enrollment. The MCP shall offer to provide care management services to any member who is enrolled in the CSP. Exceeding medical necessity may include: a. Receiving prescriptions for 12 or more controlled substances in 90 calendar days; or b. Receiving controlled substance prescriptions from 4 or more pharmacies in 90 calendar days; or c. Receiving controlled substance prescriptions from 4 or more prescribers in 90 calendar days; or d. Receiving medical services for diagnoses including substance abuse, or poisoning, or that indicates a pattern of using services to obtain controlled substances not medically necessary or are a result of substances being used in a way not medically necessary. 2. The MCP shall issue a notice of enrollment in CSP to members who, during a 90 calendar day period: a. Received four or more abuse potential drugs, as defined by ODM; b. Have a history of addiction and/or drug dependence with abuse potential drugs, as defined by ODM; and c. Obtained prescriptions for abuse potential drugs, as defined by ODM, from four or more prescribers. For the purposes of this requirement, any 90 calendar day period shall include up to July 1, 2018 and beyond (e.g. April 2, 2018 through July 1, 2018).