12/06/2023

OSMA Advocacy Leads to More Than $400 Million in Increased Medicaid Reimbursement

OSMA’s top legislative priority for 2023 was to increase Medicaid reimbursement for physicians. Working with the administration, a provision to increase the Medicaid fee schedule was included in the initial budget proposal and remained in the version passed by both the House and Senate—and ultimately signed by the governor at the end of June.

OSMA worked with the Ohio Department of Medicaid (ODM) as it drafted rules to update the fee schedule. The rule will be passed by the end of 2023, and the new fee schedule will become effective on Jan. 1, 2024.

ODM estimates that the increases in the professional fee schedule for non-institutional providers (this includes physicians) will result in $415 million in new funding in the next year. Specifically, most codes will be increased by 5% or more. While still resulting in payments below Medicare and private payers, these increases will benefit most OSMA practices and their Medicaid patients.

What should practices do to prepare for the rate increase implementation?

• Review the final fee schedule proposal now and assess the impact on your practice. 
  
  
• Knowing that most Medicaid patients are covered by the different Medicaid Managed Care Organizations (MCOs), be sure to review your contracts with these companies to see if the rate you’re being paid is linked to the fee-for-service Medicaid fee schedule. This is the fee schedule that will be updated to reflect the increases in payments.
  
  
• Once the new fee schedule is in place on Jan. 1, be sure to monitor your claim payments to ensure any codes that have seen increases are being reflected in your payments.