News for Ohio Medicaid Providers

Focus on the Individual rather than the business of managed care

Ohio Department of Medicaid

ODM Press

December 22, 2023


The ODM Press is a periodic email update on the progress of the ODM strategic initiatives for providers, associations, and advocacy organizations.


In This Issue:


Reimbursement rate increases

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Ohio Department of Medicaid (ODM) is pleased to announce the rollout of substantial reimbursement rate increases effective January 1, 2024. As part of Governor Mike DeWine’s commitment to making sure every Ohioan receives quality care, and with the support of the General Assembly, these rate increases, outlined in the Fiscal Year 2024-2025 operating budget bill, support providers as they continue delivering the highest level of care for Ohio’s residents.

The rate increases are historic in nature, totaling approximately $3.4 billion per year across a network of more than 200,000 active providers. In July, ODM implemented nursing facility rate increases. In addition, other provider types benefiting from the rate increases going into effect in January include:  

  • Non-institutional providers.
    • Transportation.
    • Dental.
    • Ambulatory surgical centers / dialysis.
    • Testing / lab / x-ray / durable medical equipment.
    • Physicians / advanced practice registered nurses / physician assistants / clinics / skilled therapy.
    • Vision and eye care.
  • Home and Community Based Services (HCBS) waiver providers.

    • Community behavioral health.
    • State plan private duty nursing / home health.
    • PASSPORT waiver providers.
    • Assisted living waiver providers.
    • Ohio home care waiver providers.
    • MyCare Ohio waiver providers.
    • Individual Options waiver.
    • Level 1 waiver providers.
    • Self-Empowered Life Funding (SELF) waiver providers.
  • Hospitals.
  • Department of Developmental Disabilities providers.

These new rates apply to January 1, 2024, dates of service and beyond. ODM reimburses all services based on the date of service, not the date the provider bills the service. More information on this change is available in our FAQ posted here: https://medicaid.ohio.gov/about-us/budget/budget.

If you also supply services through a contract with one of our managed care entities, including MyCare Ohio plans, please contact the plan with questions about how these rate changes may affect your contracted rates. Managed care entity provider hotlines are available here: https://medicaid.ohio.gov/resources-for-providers/managed-care/provider-mcp-resources.

Copies of budget stakeholder briefings and provider rate trackers are available here on the ODM budget webpage. For additional questions, providers can contact the ODM Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available 8a.m.-4:30 p.m. Eastern time Monday – Friday.

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Nursing facility claims reprocessing

Ohio Department of Medicaid (ODM) remains committed to identifying and correcting any errors in a timely and transparent manner. ODM recently identified an issue resulting in underpayment of nursing facility fee-for-service claims. To correct this issue, last week ODM reprocessed the majority of these nursing facility fee-for-service claims with correct pricing. In January, ODM will finish reprocessing and correcting nursing facility claims that we paid incorrectly due to a defect on the Share of Cost/Patient Liability.

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What action do providers need to take? 

Providers do not need to take action on this issue. ODM is reprocessing adjustments on behalf of providers. 

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For additional questions 

If you have any questions or concerns, please contact Ohio Medicaid’s Integrated Helpdesk at 800‐686‐1516 or email IHD@medicaid.ohio.gov.  Representatives are available 8 a.m.‐4:30 p.m. Eastern time Monday‐Friday. 

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Do you have patients or families that want to learn about OhioRISE? Share the Resources for Members and Families webpage!

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Ohio Department of Medicaid’s OhioRISE program is a specialized managed care program for youth with complex behavioral health and multisystem needs. If you have patients or families that need more information about the OhioRISE program, point them to the Resources for Members and Families webpage which has everything they need to know!

Who can benefit from the OhioRISE program?

Children and youth who…

  • Have multiple needs that result from behavioral health challenges.
  • Have multisystem needs or are at risk for deeper system involvement.
  • Are at risk of out-of-home placement or are returning to their families from out-of-home placement.

Who is eligible for the OhioRISE program?

Children and youth who may be eligible for OhioRISE must meet each of the following criteria:

If you are interested in learning about the OhioRISE program and how to determine eligibility to begin the referral process, visit the Resources for Members and Families webpage. 

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Feel free to distribute the information contained within this update to your colleagues, organization's members, or with anyone who you think might find it useful. We want all Ohioans to know what is going on with ODM's strategic initiatives.

Please also encourage anyone who you think might be interested in receiving similar updates to subscribe to the ODM Press. To view our past newsletters, please visit our website here.

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