Client Alert- Ohio Medicaid Proposes Sweeping Changes to Behavioral Health Coverage Rules- What Providers Need to Know

The useful part

The proposed rulemaking encompasses 11 rules—six proposed for amendment and five proposed for rescission and replacement with new rules—and would affect virtually every community behavioral health provider in the state. This shift means that service limitations could change at any time outside of the formal rulemaking process. Providers will no longer be able to rely solely on the Ohio Administrativ...

How it works

• Permits ODM to Authorize Limits on Services Without Having to Seek Rule Changes Perhaps the most substantial change is the proposed replacement of fixed, rule-based service coverage limits with a flexible,...

What to take from it

Overview The Ohio Department of Medicaid (ODM) has circulated proposed revisions to its behavioral health coverage rules that, if adopted, would represent the most significant restructuring of Medicaid-covered behavioral health services in Ohio in years.

Example or evidence

• Under the proposed revisions, ODM would gain the authority to impose or adjust limitations on service initiation, continuation, frequency, scope, duration, and same-day allowances through a master list...

Details worth keeping

These draft rules have not yet been formally filed. They were presented by ODM Director Scott Partika to ODM Clearance Reviewers as part of a revision package motivated by three objectives: (1) fulfilling Ohio's five-year rule revision requirements, (2) updating and clarifying existing Medicaid policy, and (3) strengthening safeguards against fraud, waste, and abuse.