The Ohio Department of Medicaid (ODM) is implementing major program‑integrity updates under Governor DeWine’s Executive Order. These measures aim to support compliant providers, protect members, and strengthen accountability across the program. They include:

• Provider payment suspensions – ODM has issued immediate suspensions for 49 high‑risk home‑health providers identified through advanced revenue‑pattern analysis, marking the first use of new emergency fraud‑prevention authorities.
• Updated behavioral health (BH) prior authorization – Beginning July 1, standardized forms and threshold‑based reviews will apply to community BH, mental health, and substance use disorder services, triggering prior authorization only after certain utilization levels to help identify duplicative or layered care.
• New data‑driven anti‑fraud platform – ODM has launched a Medicaid Analytics & Detection system, using predictive modeling and composite risk scoring to better target oversight and enforcement efforts.

Electronic Visit Verification (EVV) rules under review

ODM is working on enhancements to Global Positioning System‑based EVV, including mandatory EVV for live‑in caregivers and potential biometric verification for high‑risk providers.  The public comment period for the rules just ended and feedback is being reviewed.

Together, these actions represent a significant shift toward earlier detection and stronger oversight. Providers are encouraged to stay current with evolving requirements and align practices accordingly. For full updates, guidance, and implementation details, please visit the Ohio Medicaid website.

The Ohio Department of Medicaid (ODM) is excited to share the May edition of the OhioRISE “Closing the Loop” flyer; a snapshot of what ODM and partners heard during the previous month’s community meetings and events, and how they’re responding to feedback and supporting communities in Ohio!

The May 2026 OhioRISE "Closing the Loop" Flyer includes:

• A highlight from a children behavioral health expert's visits to Psychiatric Residential Treatment Facilities (PRTF) to discuss strengthening the System of Care.
• A spotlight on the Multi-System Youth (MSY) program's application May 18, 2026 re-opening.
• An update on the OhioRISE Data Sharing Plan, including the announcement of a public OhioRISE Data Dashboard to be published in 2026.

The "Closing the Loop" flyer is regularly published  on the OhioRISE website on the Monthly Program Updates tile.

Have questions, feedback, or a Success Story for the OhioRISE program? Share your thoughts by emailing OhioRISE@medicaid.ohio.gov.

The Ohio Department of Medicaid (ODM) is committed to safeguarding provider data. To support that commitment, ODM has updated the Provider System Administrator Change Request process and introduced new requirements and recommended best practices to ensure strong data integrity and confidentiality.

Updated PNM Administrator Change Request Form

Effective January 1, ODM released an updated PNM System Administrator Change Request Form (ODM 10304). The revised form adds a new requirement and includes a full ODM review for administrator changes within facility, group or organizational provider types.  

Option 1 – Organizational Administrator Change (Non–Self-Service)

Use Option 1 ONLY when the PNM self-service option is unavailable and the organization needs to change the PNM Administrator.

This option requires:

• A completed ODM 10304 form, and
• A letter on organizational letterhead, signed by an authorized senior leader, stating: “The PNM Administrator Change Request has been reviewed and approved by the appropriate staff within the organization."

Submit both documents to the ODM Integrated Help Desk (IHD) at IHD@medicaid.ohio.gov. Requests submitted under Option 1 require full ODM review and additional processing time. Providers are encouraged to use the PNM self-service option whenever possible for immediate updates.

Option 2 – Individual Providers

Option 2 applies to individual providers who need to assign someone else to serve as the PNM Administrator when the self-service function is not available.  These requests are subject to standard reviews, and most are processed quickly.

Recommended Security and Compliance Practices

To support secure and consistent system administration, ODM recommends that providers:

• Establish clear governance structures defining roles, responsibilities, and decision-making authority.
• Maintain written policies and procedures for compliance and oversight.
• Document approval workflows to support accountability and transparency.
• Develop contingency plans to ensure continuity during administrative changes.

By adopting these practices, ODM aims to promote secure, consistent, and accountable management of PNM administrator roles.

Questions? Contact the ODM Integrated Help Desk at IHD@medicaid.ohio.gov.

Thank you for your continued partnership in supporting Ohio Medicaid.

The Ohio Department of Medicaid (ODM) is implementing a temporary moratorium on the enrollment of new Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers. This action aligns with federal guidance issued through CMS-6099-N and is authorized under 42 CFR 455.470. ODM is implementing this optional moratorium to support federal program integrity efforts and to ensure consistent oversight of high-risk provider types.

Moratorium Effective Dates: June 10, 2026, through December 10, 2026.

What This Means for Providers and Stakeholders:

• ODM will not accept new Medicaid enrollment applications for DMEPOS suppliers during the moratorium.
• Existing enrolled providers may request a DMEPOS specialty during this period.
• Currently enrolled DMEPOS providers may continue to provide services, bill Medicaid, and update their provider information as needed.
• Revalidations and changes to existing provider records will continue to be processed.
• Exceptions are allowed as permitted under 42 CFR 424.570(a)(1)(iii) and 42 CFR 424.550.

Providers and stakeholders with questions may contact the ODM Integrated Help Desk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov.

Resources:

• CMS-6099-N CMS Announcement of Nationwide Temporary Moratoria
• DME Nationwide Moratorium Q&As