04/29/2022

ODM gives plans deadline for HB169 payments

ODM gives plans deadline
for HB169 payments

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On April 4, the Ohio Department of Medicaid (ODM) sent out a communication to providers letting them know that ODM had received approval from the Centers for Medicare & Medicaid Services (CMS) for the managed care portion of provider relief payments as appropriated by the Ohio General Assembly in HB 169. This approval impacted the following categories:

• MyCare
• Hospice
• Home Health
• Community behavioral health
• Non-institutional durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)

In that communication ODM also shared that they had been working with the plans to get funds distributed quickly. ODM has given the plans until May 4 to make these payments to providers. Please note that providers will almost certainly receive multiple checks from multiple plans. 

Information about how much providers should be receiving, and from which plan can be found using the ODM provider relief dashboard located on the ARPA HCBS webpage of the ODM website.

VERY IMPORTANT - PLEASE NOTE:

• The managed care preprint relief payment is calculated as 10% of claims, however the amount providers will receive with this first payment is 50% of the total.
• This was required by CMS in order to avoid a situation where a provider may be “overpaid”.
• At the end of calendar year (CY) 2022, ODM will reconcile a provider’s total claims to actual CY22 claims experience and a final relief payment will be calculated.
• There is no action required on the part of the provider during this reconciliation process.
• ODM will work with the plans at the end of the year on this final installment of relief.
• ODM will send out an announcement when the final installments are prepared and post the final amount of payment to the dashboard.

ODM also apologized for the complexity of the process and appreciates the understanding of providers. The complexity was not foreseen when the payments were initially planned as a way to maximize the federal match for the relief funds. Questions related to the HB169 provider relief funds may be directed to Susan Wallace at swallace@leadingageohio.org.