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As described in the BH Bulletin published on February 27, Medicare began covering certain services provided to Medicare beneficiaries by marriage and family therapists and mental health counselors, as well as Intensive Outpatient Program services furnished by hospital outpatient departments, Medicare-certified community mental health centers, opioid treatment programs, rural health clinics, and federally qualified health centers effective January 1, 2024.
In the previous bulletin, we indicated that Ohio Department of Medicaid and MyCare Ohio plans would continue to pay claims for services to Medicaid enrollees with dual Medicare and Medicaid eligibility for impacted providers and services for claims submitted through June 30, 2024.
Deadline ahead.
Effective July 1, eligible practitioners should be enrolled in Medicare and Medicare-covered services should be billed directly to Medicare accordingly.
To assist providers, ODM has updated the Medicare and TPL Bypass List to reflect Medicare behavioral health coverage changes. Please note, ODM has simplified the format of this list to make it easier for provider use. The updated document lists only those procedure codes or procedure code and rendering provider combinations that may bypass Medicare and bill Medicaid directly. Also note, the Medicare and TPL Bypass List only applies to claims submitted by Medicaid provider types 84 (Community Mental Health Agencies) and 95 (Substance Use Disorder Treatment Providers).
Reminder!
As a reminder, for any payments made by Medicaid before or after June 30, including payments made by Medicaid managed care entities, if Medicare is later found to be the liable payor because the provider’s Medicare enrollment was active and the service was Medicare-covered, the Medicaid payment will be recouped.
For additional information about coordination of benefits with Medicare, please refer to the BH Provider Manual and the BH Bulletin published on February 27.
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