The Ohio Academy of Family Physicians and other physician associations met with Ohio Department of Medicaid Director John McCarthy for the last time on December 14 as he will be leaving the department on Thursday, December 22, to pursue consulting opportunities.
The OAFP has appreciated Director McCarthy’s willingness to meet on a regular basis to openly discuss opportunities and concerns.
Items discussed during the meeting included:
- Update on Ohio’s Comprehensive Primary Care (CPC) initiative – To date, 91 practices have been accepted for the 2017 Ohio CPC program out of 150 applicants. Once the names of the CPC Plus practices have been released by the Centers for Medicare and Medicaid Services (CMS), they all will be invited to apply for Ohio’s CPC program.
- Healthy Ohio 1115 Waiver – Ohio’s Healthy Ohio 1115 Waiver was rejected by CMS as being unaffordable for Medicaid recipients and too complex. Whether to pursue another future waiver is under discussion and will be dealt with as part of the state budget process but the Medicaid budget will definitely contain personal responsibility provisions. As states become responsible for 5% of costs related to Medicaid expansion, we can expect to see more waiver requests submitted by states. And, of course, repeal of the Affordable Care Act (ACA) and provisions of any replacement would impact Medicaid expansion in yet to be determined ways.
- Price Transparency – Even though all physician and other health care organizations have stated “loudly and clearly” that the price transparency statute scheduled to go into effective Sunday, January 1, 2017, is unworkable and impossible to implement, the report of the Health Services Price Disclosure Study Committee is still unwritten and the rules to implement the statute are not promulgated. Fortunately, the statute contains no penalties for failing to adhere to the law so we continue in a holding pattern. The price transparency provision of the law requires physicians and other health care professionals to offer, upon request, a good faith cost estimate at the time of service for all non-emergency services provided to the patient. Technically, the unworkable law goes into effect Sunday, January 1, 2017, with no rules to implement it and no penalties for not following it. Legislators see the need for improved health care price transparency, but don’t necessarily understand how complex and difficult it is to make it happen.
- Re-Writing the Graduate Medical Education (GME) Funding Distribution Formula – It was anticipated that rebalancing the GME funding distribution formula would be completed by September 2016 so that phase two of rewriting the formula (adjusting the formula so that it incentivizes the production of the kinds of physicians Ohio needs to meet its population health needs) could begin. Efforts in both phase one and phase two have been delayed and will now likely be part of the state budget process.
- State Budget Update – The next state budget is expected to be very tight as state revenue has been coming in way under budget. Medicaid spending is also down so that will offset some losses. The Kasich administration wants to keep Medicaid expansion in the budget, is looking at a variety of ways to fill budget shortfalls, and will be closely monitoring ACA repeal and/or replace activity at the federal level. If any new money can be squeezed out, primary care is still the priority as to payment increases.