Ohio – State Medicaid Launches Behavioral Health Care Coordination Program

February 2018 ~

This summer, Ohio Medicaid will begin enrolling beneficiaries with serious mental illness (SMI) or addiction disorder in its new behavioral health care coordination program.

The program is the final stage of Ohio’s four-part Medicaid Behavioral Health Redesign plan that aims to expand access to mental health and addiction treatment services and modernize regulations and business practices of providers across the state.

  • Shift Medicaid match to the state to ensure more consistent provision of treatment services statewide, supported by Departments of Medicaid and Mental Health and Addiction Services.
  • Expand Medicaid coverage to include more low-income residents with behavioral health needs who previously relied on county-funded services or went untreated.
  • Expand Medicaid services for individuals with the “most intense need” and update Medicaid billing codes for behavioral health providers to align with national standards.
  • Coordinate physical and behavioral health care services within Medicaid managed care to support recovery for individuals with a substance use disorder or mental illness by enrolling individuals with behavioral health needs in a private?sector Medicaid managed care plan.
  • Ohio Medicaid and Mental Health and Addiction Services (MHAS) will restructure all Medicaid reimbursed behavioral health services under managed care and explore new ways to pay for those services that reward providers who improve outcomes while holding down costs.

The first two stages have been accomplished and the final two are currently underway.

In 2012, Medicaid match requirements have been “elevated” to ensure a more consistent provision of Medicaid treatment services across Ohio and the state is now responsible for providing the Medicaid matching funds.

Then in 2014, Coverage has been “expanded” to include more low-income over 630,000 individuals with behavioral health needs who previously relied on county-funded services or went untreated now have access to treatment.

Since the start of the new year, a number of Medicaid billing codes have been “modernized” and expanded (17 to over 120 codes) to align with current procedures and standards and more accurately represent the services performed by providers. As well, Medicaid rehabilitation options are being expanded for individuals with the highest intensity needs, including Opioid Treatment Program (OTP), Assertive Community Treatment (ACT), Intensive Home-Based Treatment (IHBT), enhanced Substance Use Disorder (SUD) benefit, adoption of SUD level of care framework, and improved care coordination.

The process to submit claims has also changed and now offers three options. Beginning January 1st, community behavioral health providers will have three options to submit Medicaid claims:

  1. Submit claims through the new beta tested system
  2. Submit claims directly through the MITS portal
  3. Participate in a time-limited, cash-flow contingency plan

Also at the start of this year, Ohio’s Redesign plan adds behavioral health services to the state’s current Medicaid managed care plan contracts as well as requires the health plans to provide comprehensive care coordination provided by qualified community behavioral health providers. Qualified providers in the new network will include community behavioral health organizations, inpatient hospitals, clinics, and specialty practitioners.

Ohio’s Office of Health Transformation’s (OHT) Patient?Centered Medical Home (PCMH) Design Team has developed a payment model that rewards primary care practices who show improved outcomes and limit the total cost of care through providing disease prevention and chronic care management. The model specifically identifies the importance of behavioral health collaboration in primary care has already been adopted statewide across Medicaid and commercial health insurance.

Effective January 1st, providers of Medicaid community behavioral health services (provider types 84 and 95 in MITS) will begin to render and bill for services using the new behavioral health coding structure and benefit package. Clients enrolled in Medicaid managed care, behavioral health services will be “carved in” to Ohio Medicaid managed care plans and services will be billed directly to the individual’s plan. Clients who are not enrolled in a managed care plan, services will continue to be paid through the Ohio Medicaid fee-for-service system (MITS).

Ohio Medicaid anticipates enrollment will begin in the summer of 2018 and the state is asking behavioral health provider organizations interested in participating to complete a readiness assessment by March 2nd.

For more information regarding the Redesign and documents outlining provider manuals and reimbursement rates, visit Ohio’s Behavioral Health Redesign page.

Source(s): Open Minds; Ohio Department of MedicaidOhio’s Medicaid Behavioral Health Redesign;