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Ohio Medicaid Developments: DME Rules, PA Project and eManuals

There have been several developments recently regarding the Ohio Medicaid program:

1)      DME rules submitted -  The Medicaid DME wheelchair rule, along with other rules submitted for ICD-10 conversion and five-year rule review, were submitted to the Common Sense Initiative for comments.  This is action the agency is required to take prior to actually filing the rules.  The rules are 5160-10-03, 5160-10-20 and 5160-10-16 and rule 5160-10-16.1.  OAMES provided comments on the proposed policies and is continuing discussions directly with Ohio Department of Medicaid staff to work through concerns.  

The wheelchair rule is generally acceptable given many revisions have been made based on OAMES and other stakeholders feedback earlier in the year, however, the one objection remains reimbursement.  The rule proposes to pay at 90% of Medicare rates.  While this is concerning, it could be catastrophic if the bid rate expansion CMS is mandated to implement on Jan 1, 2016, is not stopped which requires a federal law change.  OAMES, AAHomecare and the entire HME industry is working hard to address this on Capitol Hill and we encourage members to be engaged with the legislators and prepared to push hard for a legislative fix once a bill is introduced by Rep. Price. 

OAMES will be meeting with ODM the week of Oct 12 prior to the filing of the rules to continue ironing out any issues.  FYI, the state's regulatory rules process takes about 90-days.  Once rules are formally filed, there’s another 30-day comment process, followed by a public hearing, possibly more rule changes, then a JCARR hearing.  ODM is aiming for 1/01/16 implementation so watch for news on future developments.

2)    PA project – As announced at the OAMES Medicaid Training Seminar on Sept. 10, ODM is updating the list of items that will require a PA in the DME and dental programs.  They are specifically focusing on reducing the number of items that must be prior authorized for coverage.  OAMES is currently reviewing a list of these changes.  If you'd like further information, contact Kam Yuricich at the OAMES office,  

3)    eManuals – Last week, we began hearing from members that the eManuals links were turned “off”.  ODM announced it was forthcoming at our seminar but we didn’t expect it this soon or sudden.  We've learned this is a result of functions and documents being moved from ODJFS to ODM.  We've complained that this is problematic for providers given than many have these rule, and MHTLs, and MALs, linked in their systems for staff in their day-to-day duties of processing Medicaid claims.  It's caused disruption and is requiring manual work that's too time-consuming.  Rules are available online currently at LAWriter at  but the MHTL’s and MAL’s and the billing instructions are not.  We’ve asked that these links be restored immediately until they are up and running at the new site.  So far, we've not been able to get this changed but we'll keep you posted.

If you have any questions on OAMES work with the Ohio Department of Medicaid, please contact Kam Yuricich at the OAMES office or 614-876-2424.

Breaking News!!  ODM Director McCarthy and his staff will be attending OAMES 35th Annual Meeting on Nov. 17 to provide a comprehensive update on the entire Ohio Medicaid program.  Mark your calendar now and join us in Columbus next month!

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