The Ohio Academy of Family Physicians received word on July 19 that the Ohio Department of Medicaid (ODM) has agreed to pull back on their new termination policy for physicians and other health care professionals related to licensing board action. ODM and the Governor’s office agreed to defer to regulatory boards as to whether or not a person is qualified/fit to practice as a Medicaid provider.
No longer will termination letters be sent due to an action, limitation, or restriction of a license, instead, ODM will allow for physicians and other healthcare professionals to be eligible to be Medicaid providers once the licensing board has determined them fit to practice and they no longer have a suspended license. Medicaid will also be reviewing all of the individuals who received termination letters during the period when implementation of the rule was altered.
The rule requires ODM to terminate the provider agreement with any provider whose license is suspended, revoked or otherwise limited. ODM had been using an elevated screening process for individuals whose licenses were disciplined based upon the provider’s personal impairment due to mental illness or substance use disorder, but recently decided to apply the rule more strictly meaning that any limitation of license by a licensing board would negatively impact the licensees’ ability to see Medicaid patients. ODM was terminating provider agreements with any provider whose license is suspended, revoked, or otherwise limited.
On July 10, the OAFP joined other members of the Medical Association Coalition (MAC), in expressing concerns with altered implementation of the ODM rule regarding Medicaid provider agreements.
The comment letter stated, in part, “Ohio’s licensing boards are granted statutory authority to define and regulate the professional practices of various healthcare professionals. The boards protect the public by assuring board licensed individuals have the necessary education and training, meet established standards, and ensure that licensees are mentally and physically fit to practice. We believe that the ODM rule conflicts with a licensing board’s authority and further believe that the licensing board should determine when a practitioner is able to practice safely.”
The comment letter continued, “Physicians and other medical professionals who have never had a history of criminal action, but are under a consent decree for addiction, mental health, or even a physical disability, should also be able to provide care to Medicaid recipients. As stated above, if the regulatory agency has determined that the practitioner is safe to practice, ODM should not impede the practitioner’s ability to provide needed care to a population of patients who often find it difficult to locate a physician who participates in Medicaid. Any rules that create a conflict between ODM and the licensing boards have the potential to limit a licensee’s employment opportunities and may result in patient access issues.”
This is a huge victory that will benefit the medical community greatly!