Medicaid Coordination of Benefits with New Medicare Behavioral Health Coverage

Beginning January 1, the Medicare program began covering services provided to Medicare beneficiaries by marriage and family therapists (MFT) and mental health counselors (MHC), and Intensive Outpatient Program (IOP) services authorized under Sections 4121 and 4124 of the Consolidated Appropriations Act of 2023. These provisions are implemented as part of two recently published final rules:

• CY 2024 Medicare Physician Fee Schedule Final Rule.
• CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-FC).

As of January 1, Medicare became the primary payer for Medicare-covered services furnished by MFTs and MHCs to individuals who are eligible for both Medicare and Medicaid. Additionally, Medicare became the primary payer for IOP services furnished to individuals eligible for Medicare and Medicaid by hospital outpatient departments, Medicare community mental health centers (CMHC), opioid treatment programs, rural health clinics (RHC), and federally qualified health centers (FQHC).

CMS recently provided guidance to states regarding coordination of benefits between Medicare and Medicaid and third-party liability under the Medicaid program. In accordance with this guidance, to allow providers time to complete the Medicare enrollment process:

• Ohio Department of Medicaid and MyCare Ohio plans will continue to pay claims for services to Medicaid enrollees with dual Medicare and Medicaid eligibility for impacted providers and services for claims submitted through June 30, 2024.
• Once practitioners are enrolled with Medicare, claims must be submitted to Medicare prior to seeking cost-sharing reimbursement from Medicaid, starting on the effective date of the provider’s enrollment with Medicare.

For any payments made by Medicaid (before or after June 30, 2024), including payments made by Medicaid managed care entities, if Medicare is later found to be the liable payor because the provider’s Medicare enrollment was active and the service was Medicare-covered, the Medicaid payment will be recouped as required by CMS.

To ensure secondary payments by Medicaid can be made, eligible practitioners that provide services to individuals who are eligible for Medicare and Medicaid should also be enrolled with Medicare. Eligible practitioners can apply to become Medicare providers through the Provider Enrollment Chain and Ownership System (PECOS) at Provider Enrollment Chain, and Ownership System (PECOS). The PECOS website offers tutorials regarding enrollment in Medicare.

Information on CMS’ coverage of these new Medicare providers is found below:

https://www.medicaid.gov/sites/default/files/2023-12/cib12142023.pdf

https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq-09052023.pdf

Empowering Communities: OneOhio Recovery Foundation Announces 2024 Regional Grant Process

The OneOhio Recovery Foundation recently announced news that we have all been waiting for: the start of its grantmaking process.

Soon, the Foundation’s 2024 Regional Grant Request for Proposals (RFP) will be released publicly, and the new OneOhio Grant Portal will go live, inviting organizations on the frontline lines of Ohio’s opioid epidemic to register in preparation for the application process set to launch in early April. It is all expected to start on March 4, when the RFP will be posted on the Foundation’s Grant Headquarters webpage: OneOhioFoundation.com/Grants.

Here is an overview of the timeline and process we can expect:

• March 4: The 2024 Regional Grant RFP will be posted online, and prospective applicants can access the registration form on the OneOhio Grant Portal.

• April 2: The 2024 Regional Grant application will go live, giving eligible entities until May 3 to apply for funding.

• Following the application submission deadline, the 19 OneOhio Region Grant Review Committees will diligently review and recommend funding for projects within their respective regions.

• The Foundation’s Expert Panel will then evaluate nominations, ensuring alignment with evidence-based practices and Ohio Abatement Strategies, leading to recommendations by the OneOhio Grant Oversight Committee and final approvals by the Board of Directors.

The 2024 Regional Grant funding cycle will allocate up to approximately $51 million in awards and will be open to a diverse range of Ohio-based organizations, including non-profits, for-profits, and government entities. All grantees must adhere to the Ohio Abatement Strategies and pass compliance checks, with funds designated for evidence-based interventions in prevention, treatment, recovery, and substance use disorder abatement.

A careful, thorough effort has been made by the Foundation’s Board of Directors and staff to create a grantmaking process that helps support prevention, treatment, and recovery efforts in every corner of Ohio. The Foundation’s grants can only be gamechangers in the epidemic, however, if they are put to work. That’s why it is incumbent upon us to spread the word and apply for grants. Please consider sharing information about the Foundation, the start of its grant process and then applying for grants that can help our communities move forward.

The opioid epidemic has left a tragic mark on every person, family and community it has touched, but that damage doesn’t need to be the last word. There can be healing, recovery and new resilience going forward, and with the significant resources of the Foundation applied to innovative efforts across Ohio, we can move forward together in strength.

Change Healthcare Disconnects Systems Amid Cyberattack

Change Healthcare, part of Optum, has disconnected its systems to prevent further impact as a result of an ongoing cybersecurity issue. Change Healthcare is experiencing a network interruption due to a cyberattack, the company stated in a notice on its website. Change Healthcare is part of health tech company Optum, which is owned by healthcare giant UnitedHealth Group as of 2022. Through its platform, Change processes patient payments for healthcare organizations across the country.

Additional reporting in the HIPAA Journal states that Change Healthcare provides prescription processing services through Optum which provides services to over 67,000 U.S. pharmacies and serves 129 million patients. Change Healthcare handles more than 15 billion healthcare transactions each year and says one in three patient records in the United States are touched by its clinical connectivity solutions. Change Healthcare is used by Tricare, the healthcare provider of the U.S. military, and all military pharmacies, clinics, and hospitals have been affected by the disruption caused by the Change Healthcare cyberattack, and retail pharmacies across the country are experiencing delays processing prescriptions and have been unable to send orders through insurance plans.

In a regulatory filing with the U.S. Securities and Exchange Commission (SEC) on Thursday, UnitedHealth confirmed that confirming that Change Healthcare had experienced a cyberattack that affected dozens of systems. At this stage of the incident response, it is too early to tell if any patient data has been exposed or stolen in the attack and neither UnitedHealth nor Change Healthcare could provide a timeline on when systems will be brought back online.

Ohio’s March Primary Highlights Fracturing House and State Races Riddled with Party Infighting

Despite wielding power in both chambers of the state Legislature, Ohio’s Republican lawmakers are far from coasting through this election season as incumbents face challengers from their own party in the midst of a bitter GOP power struggle. Next month’s primary will likely be used to further wage the infighting that’s been steady in the state House since 2023, when a contentious House speaker race split the lower chamber’s Republicans. Even though GOP lawmakers hold supermajorities in both chambers, the Legislature succeeded in setting a record last year for the lowest number of bills passed since the 1950s. Democrats are deciding a few contested primaries themselves, but even newly drawn Statehouse maps backed by both parties make it all but impossible for them to gain the majority in 2024. All 99 seats in the Ohio House are up for grabs this year, as are 16 of the 33 seats in the Senate.