STATE POLICY ISSUES
OACHC'S public policy and advocacy efforts are dedicated to promoting the value of Community Health Centers to Ohio's elected and appointed officials, both on the state and federal levels. OACHC staff work closely with Ohio's Congressional Delegation, Ohio's General Assembly, the Governor's Administration and other government agencies, to provide input on legislation and policies of interest to Ohio's Community Health Centers.
The overarching goal for OACHC state advocacy initiatives is to ensure that Ohio’s Community Health Centers have the resources to provide care to Ohioans, regardless of income or insurance status.
Members only: Stay up-to-date on state legislation OACHC is tracking with the OACHC Legislative Tracker
Ohio Regulatory Updates
ODM Releases Telehealth Billing Guidance; Systems Work to Be Complete April 15
The Ohio Department of Medicaid has posted its Telehealth Billing Guidance under Governor DeWine’s Executive Order and expanded, emergency telehealth rules. The systems work is expected to be complete and live April 15.
The COVID-19 rules are ongoing, please check back for additional updates. For more important information on COVID-19, click here.
Qualified Entities and PE
OACHC provided comments to Rule 5160-1-17.12 (Qualified entity requirements and responsibilities for determining presumptive eligibility). With leadership and support of the Ohio FQHC 340B consortium, the Ohio Department of Medicaid (ODM) updated their Presumptive Eligibility (PE) letter to include pharmacy guidance and help desk contacts specifically for pharmacists. The letter will include contact information for Change Healthcare, ODM’s pharmacy benefit adminstrator. If presented at the pharmacy and presumptive eligibility information is not available, pharmacy staff will be directed through the updated PE letter to contact Change Healthcare at 1-877-518-1545 (24 hours a day, 7 days a week) to confirm eligibility. The BIN is also being added to the PE letter.
ODM Provider News: New Standard Authorization Form
Standard Authorization Form (Form Number: ODM 10221), is now available under the Ohio Department of Medicaid Provider Tab with the purpose of improving care coordination for a patient across multiple providers by making it easier to share protected health information in a secure manner. The form is applicable to all covered entities in Ohio. It is not required to be used, but a properly executed form must be accepted by the receiving entity.
MEDICAID ADVISORY LETTERS (MAL)
Advisory Letter (MAL): Guidelines for Urine Drug Screen Services
The Ohio Department of Medicaid (ODM) provided guidance to address the concerns regarding overutilization of urine drug screens (UDS) being performed on Medicaid eligible individuals receiving substance abuse treatment. Read the MAL here that is effective July 1 for the Managed Care population ONLY (FFS implementation is delayed until further notice).
ODM’s Medicaid Advisory Letter (MAL) on the payment of LARCs explicitly allows the billing of a medical encounter for insertion and separate payment may be made for a LARC device or implant, including FFS patients.
ODM will be requiring the MCPs to use the MITS “Provider Master File” (PMF) to verify enrollment information and to determine which individual practitioners are affiliated to each center. It will be important for FQHCs to keep their enrollment and affiliation information up-to-date in MITS. According to ODM, everything can be done by the provider by following the Enrollment and Group Member Linkage Instructions.
Now the MCPs are using their own rosters to determine who is working at each health center. Rosters will continue to be used for other purposes, but the PMF will be used to verify some enrollment information and to determine affiliation. At some point, if practitioners’ enrollment and affiliation information is not up-to-date in MITS, FFS and MCP claims may deny.
ODM’s Non-Emergency Transportation
Use and share the Non-Emergency Transportation Services resource to help answer the question “Where can I call for transportation assistance to Medicaid appointments?”.
This rule allows OTP Medication Units (methadone) to locate at FQHCs (among other locations), effective Jan 1, 2019. Additional resource: a map of OTPs and OBOTs in Ohio.
Ohio Department of Medicaid (ODM) Website Refresh
The Ohio Department of Medicaid’s Managed Care webpage now only has items related to providers and managed care. Reports have been moved here. Managed care contracts, addenda, FAQ, and plan guidance can be found here. Lastly, the MyCare webpage reflects more current updates.
FQHC/PPS Rule Package
Visit here for the “Chapter 5160-28 Cost-Based Clinic (FQHC, OHF, RHC) Services” – more commonly known as the FQHC/PPS Rule Package in the Ohio Administrative Code (OAC).
For legislative or public policy information, contact Kelly Carey, Director of Policy & Public Affairs email@example.com.