94% of Providers Submitting Claims Have Had at Least One Payment, Nearly 1 in 3 Have Yet to Submit

It has now been more than six weeks since the Ohio Department of Medicaid (ODM) and the Department of Mental Health and Addiction Services (ODMHAS) launched Behavioral Health Redesign on a fee-for-service basis and via the MyCare Ohio plans. In that time, 433 unique providers have submitted claims to ODM for newly available and recoded mental health and substance use disorder services. Ninety four percent of these providers have successfully been paid for their claims, with a cumulative total of $56.7 million in claims paid for services between January 1 and February 13, 2018.

At the February meeting of the Joint Medicaid Oversight Committee (JMOC), legislators from both parties had questions about the nearly 200 known behavioral health providers who have not yet submitted claims in the new system. ODM Director Barbara Sears explained that more than 30 of these providers were not likely to be significantly impacted by Redesign since they had not submitted a behavioral health claim to ODM in the twelve months before the launch. An additional 46 provider agencies, who have not yet submitted a claim in the new system, have registered for ODM’s advance payment contingency plan. This will allow them more time to transition to the new coding requirements. Sears and her staff confirmed that ODM is actively conducting outreach with 131 other providers who have not yet submitted claims, offering technical assistance to ensure a smooth transition to the new billing system. She suggested that some providers may not be in a hurry to submit claims, especially those that have strong cash flows and are not heavily dependent on Medicaid populations for revenue. Providers have up to a year to bill Medicaid after services are rendered.

Despite concerns among JMOC members that Behavioral Health Redesign might be disrupting cash flow for some providers or preventing services from being rendered, ODMHAS Director Tracy Plouck assured the committee that the department has no reason to believe that any gaps in service have occurred as a direct result of the redesign. Based on regular communication between ODMHAS and the 51 county behavioral health boards, the department has been made aware of several mergers among providers, but none resulting in a loss of system capacity. Director Sears noted that when accounting for the contingency payments made to providers who have not yet submitted claims, ODM’s behavioral health expenditures for January closely resemble department’s projections made last summer. This indicates no major reduction in the availability of services. According to Director Sears, ODM will be able to conduct deeper analysis of payments made for specific services this year, as compared to previous years, once the Department has seen more maturity in claims several months from now.

Meanwhile, Ohio’s five Medicaid Managed Care plans are testing claims with providers, as well as contracting and credentialing to meet provider network requirements, in preparation for the July 1, 2018 carve-in of behavioral health services into managed care. Emily Higgins, representing the Ohio Association of Health Plans, assured the committee that the plans remain comfortable and confident that they will be prepared to go live on July 1.

JMOC will reconvene on March 15, 2018.