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Ohio Department of Medicaid Updates: Key Changes to Physician Reimbursement Rates in Early Parenthood

Client Alert
December 3, 2025

The Ohio Department of Medicaid (ODM) has proposed amending Ohio Administrative Code Rule 5160-1-60 related to covered Medicaid reimbursements for physicians. At a hearing held November 14, 2025, ODM received no comments on its proposed changes. Beginning on January 1, 2026, ODM is proposing an increase to rates for prenatal care, childbirth, and infant care and provider visits.

The following services are proposed to have increased max payments or will be covered for the first time:

  • H1000 TH* Prenatal care: at risk assessment ea addl (NEW)
  • H1001 Prenatal care: antepartum management
  • H1002 Prenatal care: care coordination
  • H1003 Prenatal care: individual education
  • S9452 Prenatal nutrition classes, non-physician
  • S9436 Childbirth prep/Lamaze classes, non-physician
  • S9437 Childbirth refresher classes, non-physician
  • S9444 Baby parenting classes, non-physician
  • S6127 Brief emotional/behave assmt
  • 99202 TH* Pre-natal office/outpatient visit, new
  • 99211 TH* Pre-natal office/outpatient visit, est
  • 99212 TH* Pre-natal Office/outpatient visit, est
  • 99213 TH* Pre-natal office/outpatient visit, est
  • 99381 Preventive visit, new, infant
  • 99382 Preventive visit, new, 1-4 yrs old
  • 99391 Preventive visit, estab, infant
  • 99392 Preventive visit, estab, 1-4 yrs old

To learn more about the proposed changes and updated Medicaid payment reimbursements, please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Jordan Burdick at jaburdick@bmdllc.com.

Ohio Department of MedicaidHealth Law
Client Alert

Ohio House Bill 537: Proposed Regulations for Midwives and Birthing Centers

January 28, 2026House Bill 537, introduced in the Ohio House of Representatives, proposes a comprehensive regulatory framework for certified nurse-midwives, certified midwives, licensed midwives, and traditional midwives. The legislation would clarify scope of practice, establish licensure standards, and impose new requirements for freestanding birthing centers and home births. Healthcare providers and facilities should be aware of the proposed changes and their potential operational impact.Client Alert

Proposed Health Information Privacy Reform Act Expands Protections Beyond HIPAA

January 26, 2026The Health Information Privacy Reform Act (HIPRA) seeks to extend privacy protections to health data not covered under HIPAA, including data collected by apps and wearables. HIPRA introduces broader definitions of protected health information, strengthens privacy and security requirements, establishes patient notification rights, and sets national de-identification standards. Companies processing health data should monitor developments to ensure compliance.Client Alert

Medicare Updates on Skin Substitutes: LCDs Withdrawn, Payment Changes Take Effect

January 23, 2026Medicare’s planned Final Local Coverage Determinations (LCDs) for skin substitutes were withdrawn in late December 2025, meaning previous coverage rules remain in effect. The 2026 Medicare Physician Fee Schedule introduces a single payment rate of approximately $127.14 for these products. Providers should review implications for diabetic foot and venous leg ulcer treatments.Client Alert

Understanding the Seven Core Elements of an Effective Healthcare Compliance Program

January 22, 2026The Affordable Care Act requires healthcare providers participating in Medicare, Medicaid, and CHIP to maintain an effective compliance program. Guidance from the Department of Health and Human Services and the Office of Inspector General outlines seven core elements that form the foundation of these programs, from written policies and compliance oversight to auditing, training, and corrective action. This alert highlights each element and explains how practices can tailor compliance programs to their size and risk profile while meeting federal expectations.Client Alert

Preventing a Board Investigation

January 21, 2026Healthcare professionals in Ohio are subject to licensing board investigations that can lead to disciplinary action. Staying compliant with regulations, documenting carefully, and operating within your professional scope can help prevent issues. If contacted by a board, working with an attorney is critical to protect your license and rights.
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