JMOC

 
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.



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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.




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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. 




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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?




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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).




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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).

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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.


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