Ohio Medicaid Announces Lifting PA Requirements

The Ohio Department of Medicaid (ODM) announced that they are lifting prior authorization (PA) requirements for fee-for-service claims that would require a PA with service dates as of 6/30/24, due to submission issues in the Provider Network Management (PNM) module.  This was communicated to the provider community in an email announcement late yesterday and ODM Press today.  Numerous PA issues have been reported to the OAMES office by members since the June 30 PNM update.  Members were advised to share these issues (and any others) with the ODM Integrated Helpdesk to allow the Department to track the nature and volume of the problems providers are experiencing in the PNM module. 

OAMES confirmed with ODM Non-Institutional Policy staff today that this applies to all Medicaid covered services including DMEPOS, which raises operational and processing implications for OAMES members.  We’ll be discussing these concerns at our next regularly scheduled meeting with ODM on Tuesday, 7/16/24, and continue communications on this important change going forward.  As we learn more, we’ll provide updates to OAMES members.  You’re advised to continue reporting any PNM issues to the ODM Integrated Helpdesk by phone at 800-686-1516 or via email at IHD@medicaid.ohio.gov so that the agency can identify, track and resolve PNM system issues at a central point of contact.

Important Update on National Provider Enrollment Contractors

Call for Questions for Next NPE East/West Meeting, Due Friday, July 19

OAMES received the following update yesterday from the National Supplier Clearinghouse Advisory Committee (NSCAC) office.  Thank you to the NSCAC members and staff for continuing to work with the National Provider Enrollment (NPE) contractors to address the backlog and other issues affecting home medical equipment providers. 

The NSCAC membership met yesterday with the National Provider Enrollment (NPE) East contractor in order to receive the latest updates on their backlogs from the transition from the NSC to the NPE and their current volume. They are making progress! There are no remaining applications from the November 2022 transition, therefore that issue has been resolved. There is still a backlog on incoming, but they report that their output is greater than their input, so we should begin to see slight improvements. 

The MAIN item the NSCAC wanted to share is that there is an upcoming deadline of July 24, 2024, for suppliers to get their EFT's sent in. IF YOU MISS THE DEADLINE - there will be a high probability your billing privileges will be DEACTIVATED. See the article from the NPE East website (in the NSCAC email) - which is the same for NPE West. ANOTHER NOTE: the NPE East contractor also indicated that if you are still receiving paper checks and you did NOT get the letter back in April, you should STILL SEND AN EFT by the deadline. See the respective NPE Contractor's website for how to submit the EFT. 

• NPE East - Novitas article
• NPE West - Palmetto GBA article

If there are further questions related to the NPE East/West Contractors, the NSCAC is currently collecting questions.  The joint NPE East/West meeting with the NSCAC membership is scheduled for Wednesday, July 31. Use this link to submit questions for the NPE East/West contactors. Questions are due by next Friday, July 19th.  If you have any issues filling out the form, please email the Council office.

Busy News Week, Don’t Miss These Time-Sensitive Issues!

Ohio Medicaid Oxygen Rule in Clearance – Public Comments Due July 16

ODM posted a draft of the proposed oxygen rule 5160-10-13 and CMN in Clearance on July 9 and comments are being accepted until Tuesday, July 16.  Affected organizations and individuals are welcome to provide input to ODM via email at Rules@Medicaid.Ohio.gov.  The Clearance notice provides a summary of key changes.  Click here for OAMES 7/9/24 ebulletin with details.  OAMES will notify members when the rule is officially filed and the public hearing scheduled. 

AAHomecare Opens Survey on Impact of Medicare Cuts – Deadline July 19

AAHomecare is conducting a nationwide survey on the impact of the expired Medicare fee-for-service 75/25 blended rate for non-bid/non-rural areas on the HME community and Medicare patients’ access to medically necessary equipment. The survey is open for another week, due Friday, July 19. All HME suppliers who serve patients in non-rural/non-bid areas are encouraged to participate. Your responses will provide data to help HME advocates make the case on Capitol Hill and with CMS for extending 75/25 rates that were rescinded on January 1, 2024. Full details available here.  Take the survey here.

NSCAC Call for Questions Open - Deadline July 19

As noted above in the NPE article, the NPE East/West contractors will be hosting a joint meeting on Wednesday, July 31. The NSCAC is currently accepting questions for the meeting which are due July 19. Use this link to submit questions for the NPE East/West contactors. If you have any questions or issues filling out the form, please email the Council office.