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Increased Medicaid Rates to Take Effect This Month for Ohio Providers

Client Alert
January 5, 2024

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.

Daphne KackloudisAshley Watsonjordan burdickMedicaid
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UPDATE - Vaccine Policy Considerations for Employers

January 4, 2021If you read our post from November, you’re already an informed employer. This first post of 2021 is to share good news, give a few updates, and answer some other common questions. Q: What’s the Good News? First, the EEOC confirmed that employers may require employees receive the COVID-19 vaccine. Second, polling indicates that the number of Americans who said they will receive a vaccine has increased from around 63% to over 71%. The number of Americans who are strongly opposed to a vaccine is about 27%. Third, initial returns show that the efficacy rate for certain vaccines is as high as 95% for some at-risk recipients.Client Alert

Changes to FFCRA Paid Leave: Congress’ Revisions to Employment COVID-19 Leave Benefits Signals the Light is at the End of the Tunnel

December 28, 2020Late in the evening on December 27th, President Trump signed into law the government’s $900 billion COVID-19 relief package (the “Stimulus Bill”). Among other economic stimulus benefits, the Stimulus Bill contains the $600 stimulus checks that will be issued to eligible individuals as well as, relevantly, changes to the Families First Coronavirus Response Act (“FFCRA”). The FFCRA was implemented in April 2020 and provided benefits to individuals who missed work as a result of an actual or suspected COVID-19 illness or to care for a child when their school or childcare service was closed because of COVID-19. Importantly, the Stimulus Bill extends eligibility for employer payroll tax refunds for leave payments made to employees on or before March 31, 2021 under the FFCRA, signaling to the American people that Congress believes many of the employed public will be vaccinated by this time, the light at the end of the tunnel. However, the Stimulus Bill does contain a caveat that employers are no longer required to provide FFCRA leave benefits after December 31, 2020, but if they do, they will receive the payroll tax credits, up to the maximums provided in the FFCRA, for payments made prior to April 1, 2021. Below we provide a list of questions and answers we received to date following the passage of the Stimulus Bill. We expect the U.S. Department of Labor (“DOL”) to issue additional questions and answers as the Stimulus Bill is implemented, and we will update this Client Alert as these are received.Client Alert

Healthcare Speaker Programs: New OIG Alert

December 11, 2020In a rare Special Fraud Alert issued on November 16, 2020 (the “Alert”), the Office of Inspector General (“OIG”) urged companies who host speaker programs to reassess their programs in light of the “inherent risks” associated with these activities. The Alert reports that, in the last three years, drug and device companies have reported paying nearly $2 billion to health care professionals for speaker-related services.Client Alert

Value-Based Care Advances – CMS Issues New Final Rules for Stark and Anti-Kickback Statutes

December 11, 2020The Centers for Medicare & Medicaid Services (“CMS”) and the Department of Health and Human Services (“HHS”) Office of the Inspector General (“OIG”) issued two highly anticipated (and quite extensive) Final Rules to reform the Stark Law and Anti-Kickback Statute (“AKS”) regulations. The Final Rules generally take effect on January 19, 2021. The Final Rules include new safe harbors for the AKS and new exemptions to the Stark Law to allow for greater flexibility. According to the HHS, the goal of updating both laws is to make it easier for providers to engage in care coordination and value-based care programs without running afoul of the statutes. Please note that this client alert could not cover the full extent of the Final Rule changes so please contact your BMD Healthcare attorney with questions.Client Alert

Mandatory Filings Under CFIUS New Rules

December 11, 2020On September 15, 2020, the Committee on Foreign Investment in the United States (“CFIUS”) promulgated a final rule modifying its mandatory declaration requirements for certain foreign investment transactions involving “TID US businesses” (sensitive U.S. businesses dealing in critical technologies, critical infrastructure and sensitive personal data) dealing in “critical technologies” – i.e., U.S. businesses that produce, design, test, manufacture, fabricate, or develop one or more critical technologies. The new rule also makes amendments to the definition of the term “substantial interest” (used to determine whether a foreign government has a substantial interest in an entity). The final rule became effective on October 15, 2020.
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