Behavioral Health Redesign provisional measures extended


behavioral health

As Ohio’s payment and care coordination system for behavioral health continues to be reworked and overhauled through the Behavioral Health Redesign, providers, patients, families and other stakeholders are facing uncertainty, financial pressure and regulatory challenges. To help alleviate some of these pressures, the Ohio Department of Medicaid (ODM) and the Ohio Department of Mental Health and Addiction Services (OMHAS) have taken several recent actions.

  • The Behavioral Health Redesign “transition of care patient protection” requirements have been extended until further notice. This includes:
    • Maintaining current fee-for-service payment rates, covered benefits and prior authorization requirements
    • Extending the timely claims submission periods to 365 days for Medicaid managed care
    • Extending out-of-network provider payment requirements
  • The plan of action for the recovery of advance payments has been delayed.  
  • Targeted teams to work on provider roster and third-party liability issues have been created.
  • Specific resources at both ODM and OMHAS have been dedicated to assist providers, particularly those who are contemplating a reduction in staff or services due to pressures from the Behavioral Health Redesign.

ODM and OMHAS are requesting that providers contact them with specific issues and concerns so these may be addressed and solved and the learnings from specific situations may be incorporated into statewide solutions.

The recent actions by ODM and OMHAS are summarized in a recent Provider Information Release.

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