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Ohio’s Managed Care Overhaul Delayed – New Implementation Timeline

Client Alert

At the direction of Governor Mike DeWine, the Ohio Department of Medicaid (ODM) launched the Medicaid Managed Care Procurement process in 2019. ODM’s stated vision for the procurement was to focus on people and not just the business of managed care. This is the first structural change to Ohio’s managed care system since the Centers for Medicare & Medicaid Services' (CMS) approval of Ohio’s Medicaid program in 2005. Initially, all of the new managed care programs were supposed to be implemented starting on July 1, 2022. However, ODM Director Maureen Corcoran recently confirmed that this date will be pushed back for several managed care-related programs.

What Caused the Delay?

Like many plans over the past two years, ODM’s rollout of the Next Generation of Managed Care was delayed partially as a result of COVID-19. The federal government is not expected to renew the public health emergency status beyond mid-July, which will trigger the required eligibility redetermination of millions of Medicaid beneficiaries. Until then, Medicaid is barred from removing anyone from the program while receiving enhanced federal matching funds provided in response to the pandemic. In order to minimize disruption for all Medicaid beneficiaries, the phased approach to introducing the new managed care system will allow time for the public health emergency to end and the new managed care plan coverage to begin. Additionally, ODM states that the staggered start will also promote continuity of care, limit confusion, and provide adequate time for provider testing and training.

The New Plan

Originally, ODM was supposed to roll out seven new managed care plans, centralized credentialing, a single pharmacy benefit manager, and a new managed care plan for multi-system youth called OhioRISE on July 1, 2022. For the reasons named above, ODM is now instituting a staggered start. Here is the new implementation schedule:

  • Stage 1, July 1, 2022 – OhioRISE: OhioRISE will provide care coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems. The program builds on the launch of a statewide network of community-based care management entities; the design and implementation of the Child and Adolescent Needs and Strengths assessment tool; and the completion of extensive community and provider training sessions for more than 1,650 participants.
  • Stage 2, October 2022 – Centralized Provider Credentialing & Single Pharmacy Benefit Manager: Centralized Provider Credentialing (CPC) will provide a single place for provider credentialing rather than forcing providers to be credentialed with each individual managed care plan. Medicaid will implement CPC through the Ohio Medicaid Enterprise System (OMES) Provider Network Management (PNM) module, which aims to reduce administrative burdens on providers and will largely replace the current MITS system. Additionally, in Stage 2, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
  • Stage 3, 4th quarter of 2022 – Next Generation Managed Care Plans: ODM will finish the three-phase implementation with the opening of all seven Next Generation Managed Care Plans to provide healthcare coverage under the new program. ODM will also complete the OMES implementation by launching the Fiscal Intermediary (FI), which seeks to simplify and streamline the provider process for submitting claims and prior authorizations.

Incumbent plans will still continue to operate as usual, including UnitedHealthcare Community Plan of Ohio, Molina Healthcare of Ohio, CareSource Ohio and Buckeye Community Health Plan. New plans include Humana Health Plan of Ohio, AmeriHealth Caritas of Ohio and Anthem Blue Cross and Blue Shield. Patients will have the opportunity to stay with their current plan or switch to a new one.

If you have any questions about any of the new Medicaid programs and how they may impact your practice, please reach out to your local BMD Healthcare Attorney or Ashley Watson at abwatson@bmdllc.com.


Community Banks: Collaboration, not isolation, is the key to protecting/ enhancing the cannabis business you pioneered

As we prepare for the plenary session of the informal institutional cannabis lenders community announced in my previous article, I am pleased to advise that participants now include 5 of the best-known dedicated loan funds; a select group of commercial banks ranging in size from single state community banks to mid-size regionals making cannabis loans into the mid-8 figures; and, a syndicator of credit union cannabis loans.

Inflation Reduction Act: Healthcare Provisions

On August 16, 2022, President Joe Biden signed into law the Inflation Reduction Act (the “Act”), a landmark climate, healthcare, and tax bill. Though the Act’s climate provisions have received most of the media attention, the healthcare aspects of the Act present some of the most significant changes to the American healthcare system since the passage of the Affordable Care Act.

The Current State of Assignment of Benefits Litigation in Florida

On May 25, 2022, Florida lawmakers approved property insurance reforms that remove attorney’s fees, with respect to assignment of benefits (“AOB”) property insurance litigation. One-way attorney’s fees are a longstanding problem in Florida and the reforms come at a time when AOB litigation increasingly affects homeowners in a negative way.

Proposed Community Revitalization Grants for Ohio Projects

Jason A. Butterworth client alert ohio tax credits historic preservation tax credits community revitalization grants

Ohio Senate Bill 225 Paves the Way for Greater Investment in Opportunity Zones and Historic Districts

Ohio Senate Bill 225 is poised to make dramatic enhancements to certain tax credit programs in Ohio, specifically those surrounding investments in “Opportunity Funds” and historic buildings. Signed into law by Governor Mike DeWine in June 2022, the Bill is positive news for real estate developers working to revitalize Ohio communities with investment and rehabilitation projects.