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The Ohio Department of Medicaid (ODM) has begun its Phase 2 Rollout of the Next Generation MyCare program. In addition to the 29 counties that went live on January 1, the program is now available in Sandusky, Erie, Henry, Williams, Defiance, Paulding, Fayette, Fairfield, Licking, and Ashtabula counties. From now until August 1, the program will continue to roll out across the state.
Impacts to Area Agencies on Aging (AAAs)
In the program, AAAs partner with the plans to support members in getting the care they need by serving as a member’s care coordinator and/or waiver service coordinator. The plan's delegation model determines how you work together to serve members.
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Full Delegation: AAAs serve as a member’s waiver service and care coordinator.
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Partial Delegation: AAAs or the plan may serve as a member’s waiver service coordinator or care coordinator.
You are encouraged to reach out to your care coordinators / waiver service coordinators, members, and providers in your area directly to help them understand the program and the steps they need to take.
Impacts to Members
Timing of benefits depends on whether – and when – members select a Next Generation MyCare plan or are automatically assigned one. Members cannot begin receiving care through a MyCare plan ahead of the date the program becomes available in their county. Additionally, those who are eligible for the MyCare Ohio Waiver will start receiving services through the waiver once their plan starts.
Once a member is enrolled with their plan, they should receive a new member ID card and other materials explaining their benefits.
As you interact with members, share the following resources to help members understand the program and the important steps they need to take before it rolls out in their county:
Impacts to Providers
In the Next Generation MyCare program, providers must enroll with ODM and contract with the MyCare plans to provide services to members. Ohio Department of Aging (AGE) enrolled providers can continue to deliver services and submit claims but must contract with the MyCare plans if they have not already.
Claims for MyCare members can be submitted to the plan’s portal using Direct Data Entry (DDE) or via Electronic Data Interchange (EDI).
For providers who are new to billing in the Next Generation program:
- Billing services in the Next Generation MyCare program is generally the same process as in the Managed Care program. If a provider submits claims for Managed Care members today, consider using the same process for MyCare members.
- If a provider does not have an existing process in place today, they should consider which option is best for them by viewing the Provider Claims Submission One-Pager or Provider FAQ.
As providers have questions, direct them to the Provider Help Desk One-Pager to know where to go for help.
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