Since July 1, 2014, the Ohio Department of Medicaid has conducted a six month pay and post period in order to implement the Federal ordering, referring, and prescribing requirement under Section 6401 of the Patient Protection and Affordable Care Act of 2010 (ACA), also found at 42 CFR 455.410. The six month pay and post period was designed to facilitate provider compliance with the requirement and ODM will end the pay and post period on January 12, 2015. For dates of service on and after January 12, 2015 claims requiring an ordering physician will be denied if they do not comply with the federal regulation.
Please note the prescribing (ORP) requirements affect the following healthcare providers:
- Hospitals (inpatient and outpatient)
- Outpatient Health Facilities
- Other Accredited Home Health Agencies
- Non-agency Personal Care Aide
- Medicaid School Programs
- Private Duty Nurses
- Hospice providers
- Wavier Services Organizations
- Wavier Services Individuals
- Clinics
- Mental Health Clinics
- Medicare Certified Home Health Agencies
- Clinical Nurse Specialists
- Pharmacies
- Nurse Practitioners
- Home and Community-Based Assistive Living providers
- Durable Medical Equipment Suppliers
- Imaging/Testing Facilities
Please go to the ODM Provider page at http://medicaid.ohio.gov/PROVIDERS.aspx for important information regarding this update.