Resources

Client Alerts, News Articles, Blog Posts, & Multimedia

Everything you need to know about BMD and the industry.

The Ohio Department of Medicaid Announces Four Next Generation MyCare Plans

Client Alert

On November 1, 2024, the Ohio Department of Medicaid (ODM) announced four managed care organizations that will become ODM’s Next Generation MyCare plans starting January 2026. MyCare Ohio is a managed care program that supports Ohioans across 29 counties enrolled in both Medicare and Medicaid.

Currently, Buckeye Health Plan, CareSource, Molina HealthCare of Ohio, Aetna Better Health of Ohio, and United Healthcare Community Plan make up the MyCare plans available to plan participants. Ohioans will continue to receive coverage under the existing MyCare plans until the Next Generation MyCare plans take effect in 2026.  

ODM’s Next Generation MyCare program strives to enhance both the MyCare member and provider experience. ODM Director Maureen Corcoran shared that the Next Generation plans were selected “after more than a year of stakeholder engagement efforts that gathered patient feedback from members, family caregivers and other stakeholders across the state.”[1] She explained that these efforts helped ODM to “understand their experiences with healthcare and the associated life choices, with a focus on how to improve individual health outcomes and population wellness.”[2] As a result, ODM awarded the following plans to serve MyCare members starting in 2026:

  • Anthem Blue Cross and Blue Shield
  • Buckeye Health Plan
  • CareSource
  • Molina HealthCare of Ohio

Members currently enrolled in Aetna Better Health of Ohio or United Healthcare Community Plan will be required to select a new plan from the list of Next Generation MyCare plans. ODM will provide these members with enrollment information before their coverage lapses in January 2026.

For MyCare members currently enrolled in Buckeye Health Plan, CareSource, or Molina Healthcare of Ohio, no action is required for those who would like to continue with their existing plan. However, they may elect to change their coverage to a different Next Generation plan.

The newly selected plans promote the program’s goals of:

  • Focusing on the individual
  • Improving individual and population wellness and health outcomes
  • Creating a personalized care experience
  • Supporting providers in continuously improving car
  • Improving care for individuals with complex needs to promote independence in the community
  • Increasing program transparency and accountability

ODM stated that statewide expansion of the program is expected to follow the transition to the Next Generation MyCare plans.

If you have questions about the Next Generation MyCare program, please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Kate Crawford at khcrawford@bmdllc.com.


[1] Ohio Medicaid Announces MyCare Ohio Plans Chosen to Serve Ohioans in Next Generation Program, Ohio Dept. of Medicaid (Nov. 1, 2024), https://medicaid.ohio.gov/news/press-release/odm-nextgen-mycare-ohio-plans.

[2] Id.


Laboratory Specimen Collection Arrangements with Contract Hospitals - OIG Advisory Opinion 22-09

On April 28, 2022, the Department of Health and Human Services, Office of Inspector General (“OIG”) published an Advisory Opinion[1] in which it evaluated a proposed arrangement where a network of clinical laboratories (the “Requestor”) would compensate hospitals (each a “Contract Hospital”) for specimen collection, processing, and handling services (“Collection Services”) for laboratory tests furnished by the Requestor (the “Proposed Arrangement”). The OIG concluded that the Proposed Arrangement would generate prohibited remuneration under the federal Anti-Kickback Statute (“AKS”) if the requisite intent were present. This is due to both the possibility that the proposed per-patient-encounter fee would be used to induce or reward referrals to Requestor and the associated risk of improperly steering patients to Requestor.

Property Owner Protection from Tax Valuation Challenges

New legislation provides significant new protections for commercial property owners against challenges to valuation primarily by local school boards and prohibiting side agreements to avoid tax valuation changes. The Ohio Legislature has approved House Bill 126 which will go into effect July 2022 but will effectively apply to the 2023 tax valuation year.

No Surprises Act Update: The IDR Portal is Open

The No Surprises Act (“NSA”) became effective January 1, 2022, and has been the subject of lawsuits and criticisms since its inception. The goals of the No Surprises Act are to shield patients from surprise medical bills, provide to uninsured and self-pay patients good faith estimates of charges, and create a process to resolve payment disputes over surprise bills, which arise most typically in emergency care settings. We have written about Part I and Part II of the NSA previously. This update concerns the Independent Dispute Resolution (“IDR”) procedure created by Part II but applicable to claims covered by Part I. The Centers for Medicare & Medicaid Services (“CMS”) finally opened the Portal for providers to submit disputes to the IDR process following some updated guidance regarding the arbitration process itself.

Updated FAQs for the No Surprises Act - Good Faith Estimates

The No Surprises Act (“NSA”) became effective January 1, 2022. Meant to protect consumers from surprise medical bills, the new law is good for consumers, but vexatious for health care providers and facilities. One particular source of frustration is the operationalization of the Good Faith Estimate (“GFE”) requirement, governed by Part II of the regulations that implement the NSA. The GFE requirements apply broadly to all healthcare providers and facilities that practice within the scope of their state-issued license.

IMPORTANT PRF UPDATE! HRSA Allows Providers the Opportunity to Correct Missed Period 1 Reporting

Late Wednesday, April 6, HRSA announced that it was going to allow providers with extenuating circumstances that prevented them from preventing a completed Period 1 Report to submit a Request to Report Late Due to Extenuating Circumstances.