Only 8% of Medicaid and 4% of Medicare Enrollees Received Behavioral Health Services

New government findings outlined in a recently issued report add details to the lack of availability of behavioral health services for America’s poor and elderly.

The Office of Inspector General (OIG) for the U.S. Health and Human Services Department found that about one-third of behavioral health providers in selected counties serve patients in the Medicare, Medicare Advantage, or Medicaid programs.

The report focuses behavioral health services offered during 2021 -- a time before significant action was taken by the agency that oversees the three programs, the Centers for Medicare & Medicaid Services (CMS), along with the White House and Congress.

Medicare spends an estimated $27 billion a year on behavioral health services, while about 1-in-4 members are coping with a behavioral health condition. For Medicaid, the cumulative spending totals about $52 billion, while adult members experience mental health conditions at a rate of 29% and substance use disorders (SUD) at about 21%, the report states. Some of the causes of the shortage are well-known in the industry: the administrative burden of participating in certain health plans (especially the prior authorization and credentialing processes), low payment rates by payers and overall provider shortages.

Potential Action Required to Avoid Medicaid Termination - PNM SSN Verification 

We wanted to ensure Ohio Council member organizations are aware that the Ohio Department of Medicaid (ODM) will be validating provider organization information in the PNM against the Social Security Administration Death Master File this weekend. Several hundred organizations, including behavioral health providers, were terminated in February the last time this was conducted. ODM has contacted the previously impacted organizations that have yet to make the required updates in the PNM since February. ODM called and sent the below email to organizations that must take action TODAY or your organization will be terminated from Medicaid and you will be required to submit a new Medicaid provider enrollment application for your organization with a required site visit. This process can take up to 90 days or longer.

If your organization received a call from ODM or the email below, ACT NOW and follow the steps outlined below to avoid termination of your Medicaid provider agreement. ODM will not be reinstating terminated organizations as they did in February. Please note, if you completed the process below and your organization is in a pending or submitted status in the PNM, you will not be terminated. If your organization was not terminated in February and/or was not contacted by ODM this week, there is no action necessary. However, providers should ensure they have a process to updated information about ownership, control interest, and managing employees in the PNM for their organization as this validation will be conducted monthly.

Action Required: Update Your PNM SSN/TIN Owner Information To Avoid Termination

Attention Medicaid provider,

All Ohio Medicaid provider organizations must disclose and maintain information about ownership, control interest, and managing employees in the Provider Network Management (PNM) module as part of their Medicaid Provider Agreement. The Ohio Department of Medicaid is required to verify that individuals and organizations disclosed for this purpose are screened against several federal exclusion databases. The PNM module automatically runs these checks on a monthly basis.

If you are receiving this email, our records show that one of your organization’s disclosed owners or managing employees is triggering a match on the Social Security Death Masterfile, a federal exclusion database. You must take immediate action to avoid termination.

Required action:

• Log into the PNM and complete an update.
• Medicaid-only providers should choose “Begin Reapplication” or “Begin Revalidation.”
• Providers with Department of Developmental Disabilities contracts need to choose “Begin DODD Enrollment.”
• Check for the following common issues:
• The person listed as an owner or managing employee is deceased and the owner or managing employee record needs to be end-dated on the provider's application.
• A person provided an employee identification number in lieu of a social security number. State and federal regulations require that individuals disclose their social security number.
• A person’s social security number is mistyped.

Note: If you submitted an update to this information that Ohio Medicaid is currently reviewing, you do not need to take any further action.

For more information:

Access the Updating or Adding Owner Information Quick Reference Guide for step-by-step instructions on how to update your provider information in the PNM. For technical support or assistance, contact Ohio Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 and follow the prompts for provider enrollment (option two, option two) or email [email protected]. Representatives are available Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.

More Americans Forgoing ADHD Meds As Shortages Drag On

Shortages of commonly prescribed drugs for attention deficit hyperactivity disorder have stretched on for nearly 18 months, with no clear end in sight for many Americans who've found it difficult if not impossible to get the treatments.

Why it matters: As demand for stimulants like Adderall and Vyvanse soared, the fill rate for such prescriptions has dropped more than 10% in two years, according to a new analysis from health analytics firm Truveta.

Patients struggling to find ADHD drugs have aired their frustrations in thousands of comments filed to the Federal Trade Commission, which is studying possible factors driving shortages.

"I have not been able to fill my prescription at any pharmacy I've been to including Costco, CVS, Publix, Walmart, and local discount pharmacies," wrote a man who identified himself as a medical student in the Miami area.

One woman said she's had trouble each month filling a prescription for her son, a sixth grader. "Recently his teacher asked him to find a way to 'just stay home' until his medication becomes available again," she wrote. "Can you imagine what it feels like for a child to hear this?"

Between the lines: Likely drivers of the shortages include pandemic-driven increases in demand, caps on production of the drugs, and the threat of rolling back rules making it easier to prescribe stimulants virtually.

Recreational Marijuana in Ohio: Process for Licensing Businesses Expected to Start in June

The Ohio Division of Cannabis Control is expecting to begin its recreational marijuana licensing process in early June, a critical step toward the state’s first legal recreational sale, which is expected not long after the state grants its first recreational license in early September.

The first batch of applications will go to each existing medical marijuana licensee beginning June 7, according to Department of Commerce. A Department of Commerce spokesperson observed they are “looking to begin awarding provisional licenses for non-medical cannabis facilities by September 7,” and recreational marijuana sales cannot legally occur until the licenses are issued and the respective facilities are certified by the division. This timeline follows the directives of the yet-to-be-altered Issue 2 statute that went into effect on Dec. 7. However, it’s ultimately a timeline that Gov. Mike DeWine and the Department of Commerce have been displeased with, given the disconnect between marijuana being legal to possess in Ohio with no legal way to procure it due to the House and Senate not enacting implementing legislation.