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The Ohio Department of Medicaid
ODM Press
March 20, 2024
The ODM Press is a periodic email update on the progress of the ODM strategic initiatives for providers, associations, and advocacy organizations.
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The Ohio Department of Medicaid (ODM) has officially begun work on the procurement of the Next Generation of MyCare Ohio. In the coming months, ODM will release a request for applications for managed care plans to serve as the MyCare Ohio plans as we transition out of the Financial Alignment Initiative demonstration and move toward a Fully Integrated Dual-Eligible Special Needs Plan (FIDE SNP) model. Plans awarded the contract will need to notify CMS of their intent to establish a FIDE SNP in Ohio by the fall of this year to be authorized to begin operations by the end of the demonstration which concludes at the end of calendar year 2025. Beginning in January of 2026, the selected FIDE SNPs will begin covering the full Medicare and Medicaid benefits for those who qualify in the current 29 demonstration counties, with statewide expansion as expeditiously as possible.
In the fall of 2022, ODM released its MyCare Conversion Charter and Principles (see here) and completed a series of meetings around the state to engage members, advocates, providers, current D-SNPs, and many others. ODM is grateful for everyone who offered feedback during this process, and we are committed to incorporating it in developing the new MyCare program, just as we did in the Next Generation of Medicaid managed care.
ODM is continuing our provider outreach efforts by conducting a series of virtual meetings with provider stakeholders. These sessions will share information on the current MyCare Ohio program and allow you time to share your experiences and suggestions navigating the current Financial Alignment Initiative demonstration and other FIDE SNP models. If you are interested in learning more or sharing your experiences, read the “Join us for an Ohio Medicaid MyCare program roadshow session!” article below.
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The Ohio Department of Medicaid’s MyCare Ohio program has exciting changes coming, including expansion of the program statewide. The MyCare Ohio program integrates both Medicaid and Medicare benefits into one program, operated by a managed care plan.
The Ohio Department of Medicaid is conducting a series of virtual meetings with provider stakeholders over the coming months. In these meetings, we expect to hear your experiences navigating the current Financial Alignment Initiative demonstration and other Fully Integrated Dual-Eligible Special Needs Plan (FIDE SNP) models. If you currently provide services through the MyCare Ohio program or are interested in becoming a MyCare Ohio provider, please join us.
The first session is a statewide virtual kick-off to provide an overview of the MyCare Ohio program and approach to these sessions. We encourage all providers to attend this virtual kick-off, but attendance is not required. Beginning in March, we will host a series of virtual sessions by provider type. Please only attend the one that best fits your provider type.
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Session Name
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Date/time
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Description
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Registration link
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MyCare Ohio program community input session kick-off
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March 26, 2024
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Session to learn about the current MyCare Ohio program and the approach of the MyCare Ohio program community input sessions.
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MyCare Ohio program community input session - Dental & vision providers
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March 29, 2024
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Session for dental and vision providers to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Behavioral health providers
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April 18, 2024
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Session for behavioral health providers to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Transportation providers
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April 26, 2024
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Session for transportation providers to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Long-term care providers
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May 7, 2024
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Session for long-term care providers to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Waiver providers
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May 22, 2024
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Session for waiver providers to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Non-nstitutional providers
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June 27, 2024
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Session for non-institutional providers to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Eligibility providers
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July 17, 2024
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Session for eligibility providers to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Advocacy groups, associations, and organizations
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August 14, 2024
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Session for provider advocates, organizations, and associations to share their thoughts on the current MyCare Ohio program.
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MyCare Ohio program community input session - Hospital providers
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September 11, 2024
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Session for hospital providers to share their thoughts on the current MyCare Ohio program.
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Learn more about MyCare Ohio and the community input sessions
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MyCare Ohio is a managed care program designed for Ohioans who receive BOTH Medicaid and Medicare benefits. This program has an integrated approach to care coordination based on member needs – a team with members at the center.
The MyCare Ohio plan ensures the member has all the available benefits of Medicaid and Medicare health coverage and simplifies how to access them. Plus, MyCare Ohio plans may include additional services to their members.
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What is the purpose of the MyCare Ohio program community input session?
ODM is reviewing today’s MyCare Ohio program to identify possible changes to better address the needs of the providers we serve. To support this, we are expanding the MyCare Ohio program statewide to allow more Ohioans to receive needed care. The expansion allows more Ohioans to take advantage of simplified care coordination and ensure continuous access regardless of where they live in the state. During this process of expanding coverage, we will also transition the program to increase transparency and reduce administrative burden for providers by implementing come of the same enhancements and requirements as the Next Generation of Ohio Medicaid program.
We are conducting a series of virtual meetings with provider stakeholders to hear your experiences navigating the current Financial Alignment Initiative demonstration and other Fully Integrated Dual-Eligible Special Needs Plan (FIDE SNP) models. Feedback collected will inform efforts to prepare you for forthcoming changes to the program.
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The Ohio Department of Medicaid (ODM) recently identified an issue with the Fiscal Intermediary that resulted in duplicative information on the PDF remittance advices (RA) for the July 13, 2023, payment date. While the RAs accurately detailed payment for the July 13 payment cycle, they also included duplicate information from the previous cycle.
To fix this issue, ODM will remove the incorrect PDF RAs. On March 27, ODM will post the corrected PDF RAs in the Provider Network Management portal. Additionally, March 27 will be reflected as the new PDF RAs run date.
The newly generated PDF RAs will be produced in the updated PDF RA format. However, ODM will title them with the previously used naming convention, which is populated with the paid date (YYYYMMDD) and the National Provider Identifier or appropriate Medicaid ID.
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What action do providers need to take?
No action is needed by providers.
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If you have any questions or concerns, please contact Ohio Medicaid’s Integrated Helpdesk at 800‐686‐1516, option 1, or email IHD@medicaid.ohio.gov. Representatives are available 8 a.m.‐4:30 p.m. Eastern time, Monday‐Friday.
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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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