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Ohio Department of Medicaid Managed Care Procurement Update


Released earlier this year, the second Ohio Medicaid Managed Care Procurement Request for Information (RFI #2) sought input from providers, associations, advocacy groups, data and information technology vendors, and managed care organizations regarding ODM's "re-imagined" managed care program.  OAMES responded to both the July 2019 RFI #1 and the March 2020 RFI #2 sharing a wide range of concerns and summarizing:

"HME plays an integral role in the continuum of care by keeping patients at home offering a cost-effective, patient-preferred setting and a strong value for our health care system. Our members’ unique perspective as homecare providers positions them to help drive optimum health outcomes and disease management centered around the patient’s life involving their families and caregivers. Given ODM’s RFI to “focus on the individual rather than the business of managed care”, we fully believe the patient’s choice of their providers is an overriding, essential component to achieve that goal in the Medicaid managed program. We also maintain that HME providers’ role should be expanded and strengthened in the delivery of care to Medicaid consumers."

According to ODM's news release, they received nearly 100 responses to RFI #2, and the feedback generally aligned to the five goals of the re-imagined Ohio Medicaid managed care program, as shown in their website graphic here.

ODM has indicated that they are taking this feedback into account in confirming the future program design. For example, they are studying how to increase uniformity across data and improve access to data while safeguarding member privacy and adhering to HIPPA and other security guidelines. They are also reviewing potential linkages and operational connections to confirm changes will provide simplicity and a uniform experience. In addition, ODM is working to more clearly define how the various components of the re-imagined Ohio Medicaid managed care program and state, provider, and vendor roles fit together.

While this sounds encouraging, OAMES remains concerned about continued discussions by the Medical Care Advisory Committee, an appointed and diverse advisory group comprised of consumers, plans and providers to develop broad guidelines for "selective contracting".  At the May 21 MCAC meeting, it was confirmed that this model could be implemented for any healthcare sector of the Medicaid program (not limited to HME such as the state's current three sole source contracts) and used by ODM for fee-for-service or managed care plans.  OAMES will continue to engage in these discussions with state officials and share news with members going forward.      

In the coming months, ODM will be finalizing the future managed care program structure while monitoring and adjusting to the current environment to verify readiness for future milestones and support smooth implementation of the future program. While the RFI phases have come to a close, the Managed Care Procurement mailbox - - remains open as a way for providers, advocates, and individuals to communicate to ODM about the current Medicaid managed care program.

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