JMOC



Joint Medicaid Oversight Committee:
Behavioral Health Redesign Beta Testing Part II


By Loren Anthes,
Public Policy Fellow, Center for Medicaid Policy 

November 16, 2017

On November 16, the Joint Medicaid Oversight Committee (JMOC) met to revisit the topic of beta testing Ohio's Behavioral Health Redesign. This time, in addition to a presentation by Medicaid Director Barbara Sears and other Kasich administration staff, JMOC heard from the Ohio Association of Health Plans (OAHP), The Ohio Council of Behavioral Health & Family Services Providers (which represents about 150 behavioral health providers), as well as a few providers themselves.

As Director Sears explained, beta testing has commenced for 179 of the 437 agencies impacted by redesign (about 41 percent), 98 percent of tested fee for service claims are being properly processed, and they have had similar success with MyCare plans, including achievement of network adequacy. OAHP, which represented Managed Care Organizations (MCOs), advanced a similar narrative, describing their efforts to close gaps in service, work on contracting with providers, and provide resources to educate and enhance providers understanding of the new system. The testifying providers, on the other hand, had a greater range of opinions on the progress of Redesign.






Read More



Joint Medicaid Oversight Committee: Behavioral Health Redesign Beta Testing


By Loren Anthes
Public Policy Fellow, Center for Medicaid Policy 

October 23, 2017

On October 19, the Joint Medicaid Oversight Committee (JMOC) met to continue the conversation regarding the progress of Ohio’s Behavioral Health Redesign. In the presentation offered by the state before next week’s commencement of beta testing for claims, the state outlined metrics they have will be using to document their progress including number of patients covered by sign-ups, number of providers enrolled, number of successfully submitted claims (varied by plan), credentialing of providers, and contracted entities. This data is being tracked by the state and was offered to the committee via example screenshots of the Ohio Medicaid and Mental Health & Addiction Departments’ dashboard that can also break down each of these data points by county and zip code. It’s also worthwhile to point out that 37 hospitals have indicated they will start submitting claims for outpatient behavioral health, 13 are already doing so. Previously, law required the majority of these services to be delivered on the community level, so this represents a new layer of capacity for the delivery system that had not previously existed.

The majority of questions from JMOC members centered on the readiness of the state to implement the new system of claims submission. While Ohio Revised Code outlined the expectations of beta testing to the administration, the threshold of what constitutes a “clean claim” (i.e. a claim submitted without any problems) was not defined as a percentage of total testing or the associated scenarios through which that testing is taking place. Senators Tavares and Burke built upon this observation, noting that the future carve-in of these benefits into managed care represents a complicating factor in determining the level of success of claims processing as the system moves away from direct governmental billing in fee for service.





Read More



Joint Medicaid Oversight Committee: Medicaid Budgeting and the Behavioral Health Redesign
By Loren Anthes, Fellow, Center for Medicaid Policy

&
Adam White, Graduate Assistant
September 27, 2017

On September 21, the Joint Medicaid Oversight Committee (JMOC) met to discuss the state budget process and the Behavioral Health Redesign and, on September 22, the state convened one of its regional forums on the redesign for providers. These two events can demonstrate how policy is discussed in the context of committee and the practical effects these discussions may have on the behavioral health system.

In JMOC, Directors Barbara Sears and Tracy Plouck presented on the Medicaid budget and the behavioral health redesign. To frame the conversation, the administration presented its current biennial funding scheme as a “gap,” citing the lack of policy tools authorized by the General Assembly in the most recent budget process. As they explained, cuts to hospital rates and adjustments to hospital supplemental payments and managed care were necessary to achieving budget neutrality in the appropriation expectations set by the legislature. This framework was not well-received by members of JMOC who made claims that the acceptance of the budget by the governor may be unconstitutional, that efforts to control costs could be made at the expense of providers and the clients they serve, and that the Ohio Department of Medicaid did not have the adequate legal authority to change payment rates. Specifically in regard to redesign, several members voiced concerns that the current budgeting proposal, and the redesign itself, could cause complications in the delivery of care for individuals with mental illness or substance use issues.





Read More

 
JMOC Hears Testimony from ODM, ODMHAS, and Behavioral Health Providers as Redesign Implementation is Delayed
By Adam White
Graduate Assistant
June 29, 2017  

After over two years of preparing to carve new behavioral health benefits into Medicaid managed care plans and recode all Medicaid behavioral health services to align with national coding standards, the Ohio Departments of Medicaid (ODM) and Mental Health and Addiction Services (ODMHAS) had announced they were ready to go live with the Behavioral Health Redesign starting on July 1, 2017. The agencies filed rules implementing the changes with the Joint Committee on Agency Rule Review (JCARR) earlier this spring after the Common Sense Initiative Office ruled the rules would not have an adverse impact on business. However, after hearing from numerous small providers that were unprepared to go forward with the new system on July 1, the Ohio House of Representatives inserted a provision in the budget bill (H.B. 49) that would prohibit the new system from going live until January 1, 2018, and further delay the carve-in of alcohol, drug addiction, and other mental health services into Medicaid managed care until July 1, 2018. Correspondingly, JCARR requested that the administration place its proposed rules in “To Be Refiled” status to allow for further review.

On Thursday, June 22, the Joint Medicaid Oversight Committee (JMOC) of the Ohio General Assembly heard testimony regarding the status of the Behavioral Health Redesign from ODM Director Barbara Sears, ODMHAS Director Tracy Plouck, and representatives from various behavioral health providers. Directors Sears and Plouck testified that the administration is respectful of the budget deliberation process and that the agencies will not refile rules affecting community mental health providers nor propose an effective date for the rules until the budget process has concluded. However, Director Sears affirmed that the hospitals are prepared to move forward with the coding changes and make the new services available as soon as possible. Therefore, ODM has refiled a rule to increase access to services for children and multi-system youth with an effective date of August 1, 2017. Director Sears noted that ODM is able to accommodate these new services sooner because the billing methodology for hospitals in the Medicaid claims system is separate from the coding changes relating to community providers.



Read More



JMOC: Behavioral Health Redesign Update

By Brie Lusheck
Public Policy Associate
March 20, 2017

The Joint Medicaid Oversight Committee (JMOC) received testimony from two state directors who provided operational updates and policy changes for the state’s upcoming behavioral health redesign implementation on July 1, 2017. The directors touched on many of the changes the Department of Medicaid and the Department of Mental Health and Addiction Services have made since their last presentation before JMOC on behavioral health redesign in December.        

From the Ohio Department of Medicaid, Director Sears provided an update on the process behind modernizing the Medicaid codes for behavioral health redesign. Sears expressed that a long-term goal of the department is to provide data that displays Ohio’s overall behavioral health spending. Having this data will allow the state to better understand the services and supports needed for both physical and mental health care. This will be accomplished by comparing the new codes and making that comparison more transparent to better understand what services are being used. This will assist the state when setting future behavioral health goals.




Read More



JMOC: The Medicaid Group VIII Assessment Findings and Highlights on the Medicaid Portion of the Executive Budget

By Brie Lusheck
Public Policy Associate
February 23, 2017

Director Barbara Sears cemented her first 56 days as Director of the Department of Medicaid by briefing the Joint Medicaid Oversight Committee (JMOC), a committee she once chaired, on the Ohio Medicaid Group VIII Assessment (Expansion) report and Medicaid highlights from the executive budget, House Bill 49.

The Medicaid Group VIII Assessment report highlights key findings from an examination on Group VIII, otherwise known as the Medicaid expansion population in Ohio. A large sample size was used to gather data to examine, from a wide variety of sources and through biometric screenings, medical records, Medicaid records, focus groups and stakeholder interviews. 




Read More



JMOC: Setting the Rate
By Loren Anthes
Fellow, Center for Medicaid Policy
October 25, 2016

            In September, the Joint Medicaid Oversight Committee (JMOC) met to discuss the preliminary report from the JMOC actuary, Optumas. During that meeting, Optumas laid out the basic process for determining the JMOC per member per month (PMPM) growth rate, and there was a review of the statutory obligations of JMOC when setting said rate. To learn more about the process and the discussion of that meeting, which may be helpful for this post, please see my blog post from September. On October 20, however, we saw JMOC officially establish their goal for the Medicaid Director at 3.3 percent. So what are the implications and how does this translate to the budget process?




Read More



JMOC: Preliminary Report from the Actuary
By Loren Anthes
Fellow, Center for Medicaid Policy
September 28, 2016

               It has been a couple months since the last Joint Medicaid Oversight Committee (JMOC) hearing, and the latest meeting covered a lot of ground in a five-hour-plus session. The majority of JMOC dealt with the behavioral health redesign, including testimony from providers and the administration. If you want to learn more about what was shared during that portion, I recommend you read the following post from Kelly Smith of the Mental Health and Addiction Advocacy Coalition. For my blog, I will focus on the preliminary report from JMOC’s actuary, Optumas. While it may not have had the depth of content (or attendance) as the “redesign” section, the implications of what was shared may have a more significant impact in the next budget, generally.

            According to Ohio Law, at the beginning of every fiscal biennium, JMOC must contract with the actuary to provide a projected medical inflation rate, determine if it agrees with the projection, and submit a report on its findings to the Governor and the General Assembly (GA). If JMOC doesn’t agree with the projection, they must develop their own rate for the submission. This report will be submitted October 25th, to comply with the requirement to have it to the Governor 90 days before he submits a state budget proposal for the upcoming year (at least January 23, 2017).




Read More

JMOC: Paying for Value
Loren Anthes, Fellow, Center for Medicaid Policy
June 28, 2016
 

The Governor’s Office of Health Transformation (OHT) has made the transition to value-based payment its main focus since it was created in the beginning of the Kasich Administration. Now, before the budgetary swan song for this governor, many of the seeds planted in those early stages are starting to bear fruit and OHT is ramping up its Medicaid work in value. This was not only the subject of recent presentations on Comprehensive Primary Care (CPC) and episodic based payments by OHT, but was also the subject of the most recent Joint Medicaid Oversight Committee (JMOC).

Read More


JMOC: Redesign Update and Panel Discussion
Loren Anthes, Fellow, Center for Medicaid Policy
June 3, 2016

The Joint Medicaid Oversight Committee (JMOC) had a lengthy discussion on May 26th regarding alcohol and drug addiction. During the meeting, which featured a panel of experts in the field, there were two main points of conversation. First, there was a “status update” by Dr. Mark Hurst, Medical Director of the Ohio Department of Mental Health & Addiction Services (ODMHAS), on the Behavioral Health Medicaid Redesign. Second, there were presentations from a number of guests representing providers and the county ADAMHS Boards.


Read More