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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.


Valley National Bank/Trulieve Loan: A Big Step Out of the Shadows

In a late December press release, Trulieve announced that it had secured a $71.5 million commercial bank loan. In addition to the amount of the loan, which may be the largest commercial bank loan to date to a cannabis company, the release prominently identified Valley Bank and featured both a quote from Valley’s Senior Vice President, John Myers, and a description of the Bank’s service platform and commitment to the cannabis industry.

The End of Non-Competes? The Impact It Will Have on the Healthcare Industry

On January 5, 2023, the Federal Trade Commission (“FTC”) announced a proposed rule that, if enacted, will ban employers from entering into non-compete clauses with workers (the “Rule”), and the Rule would void existing non-compete agreements. In their Notice, the FTC stated that if the Rule were to go into effect, they estimate the overall earnings of employees in the United States could increase by $250 billion to $296 billion per year. The Rule would also require employers to rescind non-competes that they had already entered into with their workers. For purposes of the Rule, the FTC has defined “worker” to also include any employees, interns, volunteers, and contractors.”

2022 Healthcare Recap and 2023 Healthcare Check-Up

As the country begins to return to a new “normal” following the COVID-19 pandemic, there are many healthcare rules changing on both the federal and state levels as a result. Thus, it is important for healthcare providers and their employers to be aware of these changing rules, and any implications they may have on their practice. Look back on healthcare in 2022 and find a checklist for 2023.

Direct Support Professional Retention Payments

On December 15, the Ohio Senate and House passed House Bill 45, which authorizes the Department of Developmental Disabilities (DODD), in conjunction with the county boards of developmental disabilities, to launch their initiative to issue retention payments to Direct Support Professionals (DSPs). These retention payments will be distributed quarterly to participating home and community-based waiver providers to address the workforce crisis in the direct provider sector. Governor DeWine needs to sign the Bill to begin the payments, but he is expected to do so by the end of 2022.

Real Estate Investors Position for 2023 Opportunities

Real estate investors weathered another year in a post-pandemic world, with the year closing with yet another interest rate increase coupled with both uncertainty and heightened interest carrying into 2023. Just last Wednesday, the Federal Reserve raised its benchmark interest rate 0.50 percentage points, shifting the target range to 4.25% to 4.50%. The new level is the highest the fed funds rate has been since December 2007 and marks the seventh rate hike this year. So what does this mean to investors, brokers, lenders, and others in the real estate world? Read a few perspectives below from stakeholders familiar with our BMD clients and the markets in which they do business.