Ohio Department of Medicaid (ODM) Request for Information (RFI)

Ohio Medicaid Managed Care Program

Feedback from Individuals and Providers

ODM is planning to conduct a competitive managed care procurement and is interested in
hearing from individuals and providers about their experience with the current managed care system
and ideas for improving member and provider experience, service quality, and system accountability.
This OOA form is pulled from the original RFI and includes only the provider-specific portion. Originally, ODM had established a July 30 deadline. We have since been informed the response deadline has been extended indefinitely and additional responses are welcome.


First Name:
Last Name:


Standardization Across Managed Care Plans

1. Provide suggestions about how ODM could promote greater consistency of prior authorization requirements across managed care plans (e.g., requiring all managed care plans to use the same state-developed prior authorization form, or having the state establish which services can/cannot be prior authorized), including the pros and cons, potential barriers, and ideas for addressing those barriers.
2. Are there certain other functions or processes (e.g., provider oversight, quality measures, reporting) that should be standardized across managed care plans? If so, please identify:
• The function and how the function should be standardized
• The pros and cons of standardizing the function
• The potential barriers to standardizing the function and ideas for addressing them

Communication About Policy Updates

3. Describe your ideas for improving managed care plan communication with network providers about updates and changes to plan policies.

Support For Administrative Requirements

4. Describe how managed care plans could help providers navigate the plans’ administrative requirements, such as submitting clean claims and resolving billing issues. Have you had any experience with a managed care plan assisting you in these areas? If so, what was most helpful?

Data Sharing

5. How could data sharing between the state, managed care plans and providers be improved? In particular:
• What data do providers want access to that they do not have access to today; how would providers use that data?
• What is the most effective way of providing data to providers?
• Are there barriers to providing the requested data; how could those barriers be overcome?
• How could data be shared and used by providers that have limited resources and technology?

Supporting Primary Care Providers

6. Describe how managed care plans could support primary care providers in integrating care for individuals enrolled with them. In particular:
• What kind of primary care infrastructure may be needed?
• What kind of training or coaching may be needed?
• How could the state/managed care plans incentivize primary care providers to improve access to care?
• What kind of primary care models should be encouraged by the state/managed care plan?

Workforce Development

7. How could the state/managed care plans support workforce development for different types of providers, including dentists, pediatric psychiatrists, primary care providers, in-home providers and licensed or unlicensed behavioral health providers?

Payment Innovation

8. What are some ways the state/managed care plans could prepare and assist providers to move through the continuum of shared accountability models that reward providers for quality and improved health care outcomes? In particular:
• How could the state or managed care plans support and increase the establishment of comprehensive primary care practices and/or accountable care organizations?
• Are there other payment innovations that the state should consider incorporating into the Medicaid managed care program?


9. What other suggestions do you have for ways the state/managed care plans could better support providers?
   - denotes required fields