Complete Story
05/23/2023
ODM Provides Payment Calculation Details on Second Round of Managed Care ARPA HCBS Funds
The following message was sent by the Ohio Department of Medicaid (ODM) on 5/22/23 as a follow-up to a previous email regarding the second half of the managed care portion of provider relief payments as appropriated by the Ohio General Assembly in H.B. 169.
Payment Calculations Explained....
American Rescue Plan Act, Home- and Community-Based Services
This message serves as a follow-up to the May 8 communication announcing the second round of American Rescue Plan Act (ARPA) Home- and Community-Based Services (HCBS) managed care payments as appropriated by the Ohio General Assembly in H.B. 169. The department has received several questions regarding the calculation method of this second payment and wants to provide the following clarifying details.
Please reference the table below. The initial pool of funds was calculated based on 10% of the value of claims of all eligible providers:
|
Category |
Percentage |
Reference period |
|
MyCare |
Approximately 10% of paid claims |
Claim period from November 1, 2020, through October 31, 2021 |
|
Hospice |
Approximately 10% of paid claims |
Claim period from July 1, 2020, through June 30, 2021 |
|
Home Health |
Approximately 10% of paid claims |
Claim period from July 1, 2020, through June 30, 2021 |
|
Community Behavioral Health |
Approximately 10% of paid claims |
Claim period from July 1, 2020, through June 30, 2021 |
|
Non-institutional DMEPOS |
Approximately 10% of paid claims |
Claim period from July 1, 2020, through June 30, 2021 |
- This was a fixed pool of funds that were appropriated for distribution. The size of the pool could not be increased.
- Fifty percent of the pool was distributed in the first round of payments based on each provider’s historical claims value, i.e., 5% of the value of each provider’s claims. This was an estimate and not a final calculation.
- Any final, actual payments to providers were required to be based on actual claims experience incurred in January through June (1H) 2022.
- The value of 2022 claims used to calculate final payments was determined by taking the first six months of claims for 2022. This was done to avoid claims lag and issues with claims held up with go-live with new systems.
- Each provider’s total payment is based on its contributing share to the calculated total value of claims for 1H 2022, less the amounts the provider received as part of the first round of payments.
- Some providers had greater claims experience in 2022, some had less, so payment amounts will vary based on those differences.
Community provider relief payments are contained in Ohio’s ARPA HCBS plan. Additional information about the Ohio plan can be found at ARPA HCBS Update | Medicaid.
For questions about any of these provider payments, please email ProviderReliefInquiries@medicaid.ohio.gov.
Maureen Corcoran
Director
