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

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.

Many of the pieces of testimony highlighted the concerns from the industry. Comments included recommendations that centered on topics such as cash flow, software compatibility, and shortness of testing timeline. However, the Centers for Families and Children of Cleveland testified to the contrary, stating that testing was going well, that systems were performing optimally, and that any additional delays would negatively impact service delivery and cash flow. Regardless of the individual testimony, members of JMOC picked up on these themes in their line of questioning.

First, a few members highlighted concerns that providers would have if billing did not translate to cash on hand, thus compromising a provider’s ability to have adequate cash flow to operate. As Jim Tassie, policy lead for the Ohio Department of Medicaid, noted, small business loans from the state are not permissible due to Article VIII of the Ohio Constitution. Additionally, members were worried that testing would technically end (November 30) before the next JMOC meeting (December 14), so they would not be able to make an adequate recommendation on next steps if they were dissatisfied with the state of testing. Director Sears explained that, while it will create operational challenges, the state will continue testing until December 15th, granting providers two additional weeks before the launch of the new billing system on January 1st. Despite concerns from some JMOC members, Director Sears felt confident the state, even with its current state of testing, would be ready by January 1.

This JMOC meeting on Redesign demonstrated a greater confidence from JMOC members regarding the project. The department will have to continue to report back out on the progress of testing moving forward, and that may ultimately result in JMOC seeking an additional delay, but a number of the detailed questions or concerns from the membership had been answered. In the end, however, it will be difficult to know whether or not these deliberations and the activities of the department have been successful until the new system launches. Until that time, the 59 percent of providers who have not engaged in the testing can take advantage of the two additional weeks granted to them by the State, otherwise it will take an expedited legislative action to compel the Department of Medicaid to change course and forego the existing statutory mandate of January 1, 2018.