Ohio Department of Medicaid Announces Single PBM Begins in October
The Ohio Department of Medicaid (ODM) will begin to launch its Next Generation Medicaid program beginning July 1, 2022, with the implementation of OhioRISE, a coordinated care program for children with complex behavioral health needs. Other Medicaid programs will be implemented in the following months on a staggered basis to keep the focus on the individual and honor member choice to allow for a smooth transition.
This staggered start ensures continuity of care, limits confusion, and reduces complexities surrounding the anticipated end of the federal public health emergency (PHE) and provides the necessary time for provider testing and training.
The phased implementation will occur in three stages:
Stage 1: On July 1, OhioRISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems. This builds on the work already underway including the selection and launch of a statewide network of community-based care management entities, the design and build of a centralized technology for the Child and Adolescent Needs and Strengths assessment tool, transition grant funding to Care Management Entities (CMEs) and MRSS providers (Mobile Response and Stabilization Services) to launch new OhioRISE services and support provider and workforce development; and the completion of extensive community and provider training sessions for more than 1,650 participants.
Stage 2: In October 2022, Centralized Provider Credentialing will begin through the Ohio Medicaid Enterprise System (OMES) Provider Network Management (PNM) module, which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
Stage 3: During the last three months of 2022, ODM will finish implementing the Next Generation program with all seven Next Generation managed care plans beginning to provide healthcare coverage under the new program. ODM will also complete the OMES implementation including the Fiscal Intermediary (FI) which will simplify and streamline the provider process for submitting claims and prior authorizations.
Ohio Medicaid is committed to launching the Next Generation Medicaid correctly. The phased timeline assures no disruption to members’ care or provider support. Eligible members will continue to receive the full complement of Medicaid benefits available today, and providers will continue serving the 3.34 million Ohioans covered by Medicaid, working with current MCOs using processes and procedures practiced today.
Additional details will be available soon to guide members, providers, and stakeholders. To keep up to date with the Next Generation of Ohio Medicaid, visit managedcare.medicaid.ohio.gov. Questions can be sent to ODMNextGen@medicaid.ohio.gov.