Today, the Ohio Department of Medicaid (ODM) released a Request for Applications (RFA) for its Next Generation MyCare program.
This RFA is for managed care organizations interested in becoming Next Generation MyCare managed care plans for Ohioans who are dually eligible for Medicaid and Medicare. The selected plans will be an essential piece in improving the health and lives of Ohioans.
All potential applicants are required to notify ODM of their intent to submit a response by June 21 at 4:00 p.m. ET by emailing IntentiontoBid@medicaid.ohio.gov. Further details are noted in the RFA.
Next Generation MyCare program
The Next Generation MyCare procurement aims to improve MyCare member and provider experience with the program. To do this, ODM is transitioning the current program out of the Financial Alignment Initiative demonstration and moving towards a fully integrated dual-eligible special needs plan (FIDE-SNP). Plans awarded a contract following a competitive procurement process will need to notify CMS of their intent to establish a FIDE-SNP in Ohio by fall 2024 to be authorized to begin operations by the end of calendar year 2025. Beginning in January 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.
ODM designed its Next Generation MyCare program to:
- Focus on the individual.
- Improve individual and population wellness and health outcomes.
- Create a personalized care experience.
- Support providers in continuously improving care.
- Improve care for individuals with complex needs to promote independence in the community.
- Increase program transparency and accountability.
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The Ohio Department of Medicaid, in partnership with Maximus, the Provider Network Management (PNM) module vendor, is excited to share that we are continuing our provider awareness and training efforts around the new features implemented in the Ohio Medicaid Enterprise System. Providers will see and utilize these new features in the PNM module beginning on June 30. There is still time to register for the PNM new features training. The training schedule is available on the PNM and Centralized Credentialing page. Below you will find how to register and a list of training topics.
Learning Management System registration
Access the Absorb learning management system job aid and follow the steps to create your account and register for training. Absorb is where you can access virtual and self-paced training sessions. If you do not have an Absorb account, you must create one to access all training sessions, answer forms, and view a variety of PNM module resources.
Training module topics include:
- Fee-for-service (FFS) dental claims submission and search.
- FFS institutional claims submission and search.
- FFS professional claims submission and search.
- FFS prior authorization submission and search.
- FFS hospice member enrollment.
- Medicaid member eligibility inquiry.
- Provider financial document access (e.g., claim transaction history, 1099, remittance advice).
For more information
To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website. If you are experiencing any technical issues accessing the PNM module or have specific questions, please contact Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. The IHD is open Monday-Friday, 8 a.m. - 4:30 p.m. Eastern time.
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