Final Push Needed by Friday for Co-Sponsors Support on State Legislation

As OAMES previously reported, legislation will soon be introduced in the Ohio House of Representatives to curtail the use of “sole source” or “preferred provider” agreements by Ohio Medicaid managed care organizations which eliminate or greatly restrict competition and patient choice of home medical equipment providers.  The patient-centered principle of this bill aligns with ODM’s “Next Generation” managed care program that is focused “on the individual rather than the business of managed care” which is scheduled for implementation on 7/01/22.

Efforts are currently underway to garner grassroots support for the bill by gaining co-sponsors prior to its introduction.  The deadline to sign-on is coming up quickly scheduled close of business this Friday, Jan. 14.  Rep. Scott Lipps reached out to fellow House members requesting support.  Those currently signed on include:  Rep. Thomas West, Rep. Darrell Kick and Rep. Jean Schmidt. 

For details including contact information and the co-sponsor request, click here.  If you need any assistance identifying your legislator, background on the issue or a sample email to send to your elected official, please email Kam Yuricich at OAMES, kam@oames.org.  Please act quickly!

OAMES Receives Promising News on ARPA Relief Funding for HME Providers

After months of efforts by OAMES, it appears HME providers will be receiving relief as part of Ohio’s funding portion of the American Rescue Plan Act (ARPA) for home and community-based service (HCBS) providers.  This incredible news was shared during a collaborative stakeholder call on Friday with the Governor’s office and Directors from the four state agencies leading this important work. 

How did we get here? 

• Ohio initiated a multi-agency effort last summer to outline a plan for ARPA provider relief within the Ohio Department of Medicaid, Ohio Department of Aging, Ohio Department of Developmental Disabilities and Ohio Department of Mental Health and Addiction Services.
• At the same time, OAMES sent letters to Gov. DeWine and ODM leadership urging that Ohio’s HME providers be included in the state’s allocation of ARPA funds.
• In July, the four Ohio agencies submitted an initial funding projection to CMS.
• In August, the agencies collaborated to publish a “Request for Information” survey to gather stakeholder feedback receiving over 400 responses including OAMES’ submission.
• On September 29, CMS requested additional details from the Ohio agencies.
• On October 13, Ohio submitted its detailed spending plan to CMS which was discussed at OAMES 40^th Annual Meeting & Exhibition on Oct. 27. Ohio continued to submit additional information to CMS which has since received partial approval.  
• OAMES continued follow-up with ODM to urge support for HME providers. In addition to the June letters and August survey submission, OAMES past president Nick Kalogeras provided OAMES' testimony at the 9/23/21 Joint Medicaid Oversight Committee (JMOC) hearing and OAMES executive director Kam Yuricich gave additional testimony at the 12/09/21 JMOC hearing on the urgent need for HME provider relief.
• Concurrent with agency efforts, HB 169 was passed by the Ohio General Assembly with provider relief components which gives the State spending authority of the federal funds. The bill was signed into law by Gov. DeWine and effective on 12/23/2021 which in addition to other directives, appropriates $529 million in immediate provider relief for HCBS approved as part of Ohio’s CMS plan.  Beyond ARPA funds, HB 169 grants additional relief for other providers including nursing and assisted living facilities, ICF/IID, hospice, and rural or distressed hospitals.

Where do we stand today?

• During Friday’s stakeholder meeting, a provider relief tracking grid was presented based on HB 169. “Ohio is proposing one-time directed payment to HCBS providers in recognition of the essential work performed” and general relief due to the economic impact of the pandemic. 
• The grid outlines the allocation of relief funds by healthcare sector which includes non-institutional DMEPOS given a “retro rate increase, approximately 10% lump sum for claim period 7/01/2020 through 6/20/2021”.  HME and supplies, home modifications and other services are also included in relief under the Ohio Home Care, MyCare, and PASSPORT programs for a “retro rate increase, approximately 10% lump sum for claim period 11/01/20 through 10/31/2021”.
• The payment process will go through MITS.  Refer to the tracking grid linked above for additional details and click here for the full 1/07/21 stakeholder slide deck. 

What’s next?

While this is not yet final and there are more steps the State must complete for CMS approval as well as adopt state emergency rules prior to implementation, after months of engagement by OAMES with Medicaid regulators and state legislators, HME providers are now recognized as HCBS providers to be included in Ohio’s ARPA relief efforts due to the public health emergency. It took an enormous amount of work to get us to this point and we’re cautiously optimistic this relief is coming for our members.  We’re waiting on final news of approval and will share details from ODM on the expected timeframe and next steps as we learn more. 

We’d like to thank Laura Williard, VP of Payer Relations at American Association for Homecare and OAMES Board member, for her leadership and assistance in these efforts.  We greatly appreciate the support and collaboration between AAHomecare and OAMES.  Also, a special recognition and thank you to OAMES president Andy Willhelm, OAMES past president Nick Kalogeras RPh. and OAMES member Carol Gilligan who worked closely with OAMES executive director Kam Yuricich in on-going discussions with Ohio Medicaid officials and JMOC members. This report summarizes what we know today but if you have any questions about ARPA funding or the relief efforts, please feel free to contact OAMES executive director Kam Yuricich.