Resources

Client Alerts, News Articles, Blog Posts, & Multimedia

Everything you need to know about BMD and the industry.

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

Providers Beware: Court Sides with Insurers in No Surprises Act Arbitration

July 2, 2025On June 12, 2025, the Fifth Circuit ruled in favor of Aetna and Kaiser in two lawsuits brought by air ambulance providers challenging how insurers calculated payments under the No Surprises Act’s Independent Dispute Resolution process. The court held that unless there is clear evidence of fraud or serious misconduct, IDR decisions will stand, reinforcing the finality of the arbitration process.Client Alert

Introducing HB 281: Enforcement of Federal Immigration Laws in Ohio Hospitals

July 1, 2025House Bill 281, introduced on May 20, 2025, would require Ohio hospitals to allow law enforcement, including federal immigration agents, to enter facilities and enforce immigration laws. The bill mandates that hospitals comply with information requests and adopt formal policies, raising significant concerns about patient privacy and access to care for immigrant communities.Client Alert

Parental Consent May Soon Be Required for Minor Mental Health Services in Ohio

June 25, 2025HB 172 proposes repealing a provision in Ohio law that allows minors age 14 and older to consent to limited outpatient mental health services without parental involvement. The bill would require parental consent for all such care and remove related language from other sections of the Ohio Revised Code.Client Alert

Community Behavioral Health Providers - Supervisor Pricing Changes Begin July 1 [Corrected Date]

June 16, 2025Effective June 16, community behavioral health providers wishing to receive reimbursement at the supervisor rate must add the HP or HT Modifier to fee-for-service (FFS) claims. Find out about the new guidelines.Client Alert

CMS Rescinds EMTALA Guidance for Emergency Abortions

June 16, 2025On June 3, 2025, CMS withdrew its 2022 guidance on emergency abortion care under EMTALA, eliminating federal protection for providers in states with abortion restrictions. This policy change could significantly impact how hospitals handle emergency care involving pregnancy complications.
Older posts
Newer posts