Ohio Academy of Family Physicians Executive Vice President Ann Spicer attended the physician associations’ quarterly meeting with Ohio Department of Medicaid Director John McCarthy on June 15.
Smoking Cessation
Pursuant to several complaints filed relative to accessing tobacco cessation medications for Medicaid managed care patients, Director McCarthy made it very clear that the department wants Medicaid clients to stop smoking and Medicaid managed care companies should not be creating any barriers to that happening. Molina and CareSource do have prior authorization requirements while the other Medicaid managed care companies don’t; Medicaid staff will be investigating complaints received and take actions necessary to elimination barriers as needed.
Healthy Ohio Waiver
During the State of Ohio public comment period, Medicaid received over 900 comments about the Healthy Ohio waiver application that the current state budget bill requires Medicaid to submit to the federal Centers for Medicaid and Medicare Services (CMS). The OAFP opposed the waiver and submitted comments in opposition. If approved, the waiver would affect one million Ohioans by requiring that they establish Health Savings Accounts and pay annually to maintain their Medicaid coverage. Director McCarthy reiterated that statute requiring submission of the waiver was drafted in such a way that gives Ohio Medicaid little discretion to shape the program or waiver application. So in keeping with the dictates of the statute, state officials will be asking federal regulators to allow premiums to be charged to nondisabled, working-age adults on Medicaid who have incomes of less than 138% of the federal poverty level, or about $16,200 a year. The waiver will be submitted to CMS for consideration, most likely by the end of June. CMS will open its own public comment period and then decide what, if any, parts of the waiver request to which it will agree. Negotiations will then occur between CMS and Medicaid (assuming that additional state legislation passes to permit those negotiations to occur).
Price Transparency
The Health Services Price Disclosure Study Committee has issued its findings stating the currently enacted price transparency statute is unworkable, not feasible, and the effort should be abandoned. Compromises have been offered but the legislative drivers of the statute, to date, continue to contend that the current price transparency statute is workable and should be implemented as written. While this standoff continues it is important to note there is no penalty for not complying with the price transparency statute.
GME Formula
Work continues on rebalancing the graduate medical education funding distribution formula. The director hopes to begin phase two of this project in September. Phase two involves adjusting the formula so that it incentivizes the production of the kinds of physicians Ohio needs to meet its population health needs.
State Budget
The department is on track to end the fiscal year in good shape. Work has already begun on budgeting for the next biennium.
Access Monitoring Plan
CMS is requiring state Medicaid agencies to present formalized plans for ensuring that reimbursement rates don’t negatively impact access to care. Ohio’s plan, which applies only to Medicaid fee-for-service, was at a meeting on June 16.
Behavioral Health Redesign
On June 15, the Ohio Departments of Medicaid and Mental Health and Addiction Services released new Medicaid billing codes and prices for behavioral health services. The new codes are estimated to generate an additional $38 million annually in payments to behavioral health providers. The new codes align with national health care payment standards that support coordination of benefits and integrate behavioral and physical health care. Provider agencies may voluntarily transition to the new code set beginning Sunday, January 1, 2017, and all providers must use the new code set after Friday, June 30, 2017.
MACRA and CPC+
Director McCarthy was particularly interested in how the OAFP was educating members about MACRA and Comprehensive Primary Care Plus (CPC+). He offered to help in any way that he could with that education effort.