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Ohio Medicaid Behavioral Health Redesign | Everything You Need to Know


The final stage of the Ohio Medicaid Behavioral Health Redesign started on January 1, 2018. I have customers in Ohio, so I always make a point to keep up with changes to their behavioral health market. There’s a lot of information about the redesign and it can be overwhelming-especially when it can potentially change your business process, so I decided to put together this blog post to help you learn exactly what you need to know about it.

Ohio Medicaid

Ohio Medicaid aims to provide accessible and cost effective health care coverage for Ohioans by promoting personal responsibility and choice through transformative and coordinated quality care.

They’re the largest health care insurance provider in Ohio, insuring 1.2 million children and paying for 53% of all births. They insure over 90,400 hospitals, nursing homes, community behavioral health agencies, and other providers delivering services for over 3 million individuals. That’s a lot of responsibility.

But behavioral health hasn’t always been the focus of that responsibility. Just half of the behavioral health population on Medicaid is seen through the behavioral health system.

When Governor John Kasich was elected in Ohio in 2010, he sought to fix that. His administration initiated comprehensive reforms that expanded access to mental health and addiction treatment services in Ohio. More individuals can receive treatment and there is increased support for mental illness and substance abuse disorders.

A 4 Part Plan

The overarching goal of this Medicaid Redesign is to support recovery for individuals with a substance abuse disorder or mental illness by integrating physical and behavioral health care services. Achieving this goal was broken down into four stages:

  1. Elevation

Medicaid match requirements were elevated to ensure a more consistent provision of Medicaid treatment services across the state of Ohio. Instead of the local treatment systems, the state is now responsible for providing the Medicaid matching funds.

  1. Expansion

Governor Kasich expanded Medicaid coverage to include more low-income Ohioans. 400,000 individuals with behavioral health needs who previously relied on county-funded services or went untreated now had access to addiction and mental health treatment. The local systems that once stressed to cover these services can focus on issues like housing and employment supports for their local residents.

  1. Modernization

The Medicaid behavioral health benefits package grew to include more services. Additionally, the Ohio Departments of Mental Health and Addiction Services (MHAS) and Medicaid modernized the behavioral health insurance codes to increase services for individuals with the most intense needs and align with national standards.

  1. Integration

Ohio Medicaid can now enroll every individual with behavioral health needs in a private-sector Medicaid managed care plan. Once the benefit package mentioned in stage three is modernized, it will be moved into managed care. The ultimate goal of this action is to better integrate physical health and behavioral health care services, thus achieving the overall goal of the Ohio Medicaid Behavioral Heath Redesign.

You Are Here

January 1, 2018 marked the beginning of stage four, integration. The aim of this integration stage is to improve care coordination and overall health outcomes for individuals with mental health and addiction service needs. All of the Medicaid reimbursed behavioral health services under managed care will be restructured by Ohio Medicaid and MHAS. They will also seek to find ways to pay for these services that rewards providers who improve outcomes while holding down costs. By incentivizing providers, hopefully more will meet these standards.

Stage four can be broken down into three areas:

  1. Care Coordination

As previously mentioned, care coordination is a goal of the Ohio Medicaid Redesign. Health plans are required to provide comprehensive care coordination with an emphasis on coordination provided by qualified community behavioral health providers. These providers include community behavioral health organizations, inpatient hospitals, clinics, and specialty practitioners.

  1. Primary Care Enhancements

A payment model was created that financially rewards primary care practices that limit the total cost of care by preventing disease and managing chronic conditions. This was adopted across Medicaid and commercial health insurance in Ohio. It emphasizes the importance of behavioral health integration in primary care-the goal of the redesign. Primary care capacity should complement the integration of these services.

  1. Provider Performance Reports

Ohio’s largest insurance plans and the Office of Health Transformation (OHT) measure and report provider performance on intense episodes-of-care using definitions and measures they developed together. The hope is to reduce the overuse of unnecessary services and define and begin reporting performance.

What Does This Mean For You

As part of the modernization stage, the Medicaid rebilling codes used by behavioral health providers were updated to align with current procedures and standards. The original group of 17 codes has expanded to 120+ as part of the redesign. With these new additions, the services performed by providers are more accurately represented.

Additionally, the process to submit claims has changed. There are three options:

  1. Submit claims through the new beta tested system via Electronic Data Interchange (EDI).
  2. Submit claims directly through the Ohio Medicaid Information Technology System (MITS) portal.
  3. Participate in a time-limited, cash-flow contingency plan.

It is important to have an established process in place and a comprehensive EHR system to make your transition process smoother. There are a lot of changes, which I know can be overwhelming, but they will ultimately impact behavioral health positively.

Don’t Panic!

Change can be difficult, no matter how positive it is. But don’t panic! There are multiple ways to seek help with billing or further information on the Ohio Medicaid Behavioral Health Redesign.

A rapid response team will be available to provide technical assistance six days a week to help providers transition to the new code set and behavioral health benefit package.

You can find more information about the Behavioral Health Medicaid Redesign here. You can also submit questions here.

And, of course, you can always refer to this guide of absolutely everything you need to know about the Ohio Medicaid Behavioral Health Redesign.

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