Increased Medicaid Rates to Take Effect This Month for Ohio Providers
Client Alert
As required by House Bill 33, Ohio’s 2024-2025 operating budget bill, reimbursement rates paid by the Ohio Department of Medicaid will increase for a wide range of providers starting on January 1, 2024. The rate increases total roughly $3.4 billion per year and apply to the following types of providers:
- Non-institutional providers:
- Ambulatory surgical centers / dialysis
- Testing / lab / X-ray / durable medical equipment
- Physicians / advanced practice registered nurses / physician assistants / clinics / skilled therapy
- Vision and eye care
- Community behavioral health providers
- State plan private duty nursing / home health providers
- Home and Community Based Services waiver providers:
- PASSPORT waiver providers
- Assisted living waiver providers
- Ohio home care waiver providers
- MyCare Ohio waiver providers
- Individual Options waiver
- Level 1 waiver providers
- Self-Empowered Life Funding (SELF) waiver providers
- Department of Developmental Disabilities providers
Beginning on January 1, 2024, the majority of the codes in the Ohio Medicaid fee schedule for non-institutional providers increased by 5% or more. Specifically, there was approximately a 5% increase for physicians, APRNs, PAs, clinics, skilled therapy providers, ambulatory surgical centers, laboratories, dialysis providers, X-ray providers, and DME providers. Additionally, there was a 5.7% dispensing fee rate increase for pharmacies, a 79% rate increase for transportation providers, and a 93% rate increase for dental providers. There was no rate increase for FQHCs. However, there was a 10% baseline rate increase for community behavioral health rates.
The increased reimbursement rates authorized by HB 33 apply to dates of service starting January 1, 2024, and beyond. Note that ODM will reimburse all services based on the date the service was rendered, not the date the provider bills for the service. ODM also reminded providers that, even after the rates are increased due to HB 33, providers must continue to charge their reasonable and customary rates regardless of anticipated reimbursement from the department. ODM’s fee schedules and rates are codified in the Ohio Administrative Code and accessible for providers on ODM’s website.
If you have questions about ODM’s reimbursement rate increases, please contact your local BMD Healthcare Attorneys Daphne Kackloudis at dlkackloudis@bmdllc.com or Ashley Watson at abwatson@bmdllc.com.