Medicaid
OHA's Medicaid Web site has updates and information on the coverage and financing of Medicaid for Ohio's vulnerable and medically needy citizens, as well as OHA's advocacy efforts to keep payments to hospitals adequate to cover the cost of care.
Medicaid is a state and federally funded program for eligible low-income and medically vulnerable people. The State Children’s Health Insurance Program (SCHIP) came into existence as part of the Balanced Budget Act of 1997. SCHIP was designed to build on Medicaid to provide insurance coverage to “targeted low-income children” who are uninsured and not eligible for Medicaid, typically from families with incomes up to 200 percent of the federal poverty level. In Ohio, Medicaid is administered by the Ohio Department of Job and Family Services (ODJFS) in conjunction with 88 cooresponding county departments. In 2009, the federal government reimburses the state almost three-quarters of every dollar spent on Medicaid health care services in Ohio.
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State operating budget for fiscal years 2010 and 2011.
Medicaid 2010 Outpatient Hospital Fee Schedules Available; NDCs Still on Hold
February 12, 2010:
ODJFS revised its Medicaid outpatient hospital fee schedules for 2010, reversing an Oct. 1, 2009, increase to specific CPT codes and services in the hospital emergency department and surgery fee schedules. Instead, ODJFS will inflate all non-charge-based outpatient hospital fee schedule payments by 5 percent, effective with services delivered Jan. 1, 2010, and after (see the October 2009 OHA Finance News for additional background) . The updated hospital fee schedules are included as attachments to HHTL 3352-09-07, which includes all changes to OAC 5101:3-2-21. The department also released HHTL 3352-10-01 with all 2010 hospital payment and policy updates.
ODJFS also states it will "open" UB-04 Revenue Code 0636 to allow hospitals to submit detail coding for drugs, effective April 1. RC 0636 is not required, but if it is used, hospitals will have to include a HCPCS J Code with it.
OHA is still waiting on word regarding a possible requirement for additional detailed coding of pharmacy items. In December, ODJFS stated it would hold back any requirement to use National Drug Codes (NDCs) while it explores other, less expensive and cumbersome options with CMS. OHA continues to recommend hospitals cease all activity on NDCs until further notice.