Joint Medicaid Oversight Committee: Behavioral Health Redesign Beta Testing

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.

While many on JMOC seem concerned with the potential disruption that redesign may entail to the delivery system, its important to take a step back and think about adjoining policies which would be equally, (if not more so), disruptive. It has been well documented that the expansion of Medicaid has deeply benefitted the behavioral health population. This benefit extends not only to those receiving services, but also county-based agencies that have seen reductions in local funding and to providers that employ clinicians, social workers and therapists. Redesign may cause a significant disruption for some behavioral health providers delivering benefits. This disruption may mean consolidation, continuum concerns, or even closure. With that said, the potential for other policies, such as a Medicaid enrollment freeze or outright termination of expansion, are more likely to dismantle the network of providers that make up Ohio’s behavioral health system.

Author’s note:

An earlier version of this blog indicated that the presentation made by the state showed the current number of claims being processed by managed plans. The data presented was for illustration purposes only as testing had not begun at the time of the hearing.