Medicaid Managed Care
OHA's Medicaid managed care page links hospitals and health care providers to the Ohio Department of Job and Family Services (ODJFS) and the Ohio Medicaid managed care plans (MCPs) on rules and policies that guide the delivery and payment of health care to thousands of Ohio enrollees.
MCPs insure health care for Medicaid consumers in the Covered Families and Children (CFC) category, which includes Healthy Start and Healthy Families, and for most non-institutionalized Medicaid consumers in the Aged, Blind, and Disabled (ABD) eligibility category. The program operates under a 1915(b) waiver approved by the Centers for Medicare and Medicaid Services (CMS) and is administered by the ODJFS Bureau of Managed Health Care (BMHC). BMHC manages the enrollment of Medicaid consumers in and out of MCPs, ensures access to health services and monitors MCP financial and quality performance.
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ODJFS Reveals Revised Medicaid Managed Care Contract Proposals
February 22, 2012:
ODJFS’ Medicaid managed care Request for Applicants, released Jan. 1, will reduce Managed Care Plan (MCP) service regions from eight to three, and is designed for four MCPs per region with an expected enrollment of at least 50,000 covered lives in each plan. MCP contracts will combine CFC and ABD programs, with approximately 38,000 ABD-covered children moving into managed care. ODJFS will select six to 12 innovative applicants with proven performance coordinating care and providing high-quality health outcomes, based on MCP contract compliance and Healthcare Effectiveness Data and Information Set (HEDIS) scores. ODJFS wants at least two statewide MCPs and each of the regions must have at least one plan specific to that region.
Care coordination, especially involving enrollees with high-risk or chronic conditions, is a key condition and ODJFS has joined forces with Catalyst for Payment Reform—a nation organization of mostly large employers—to share principles and guidelines on value-based health care purchasing. MCPs are expected to organize value-added payment and delivery models, effective in 2013, although the RFA is vague on how incentive payment plans should be developed and how providers will share in goals and rewards.
Initial MCP selection is expected in April, based on plans’ ability to immediately meet contract and coverage requirements. ODJFS will be working on plan agreements and contact specifications through the end of March, during which it will take comments from OHA and others. Final agreements and all plan announcements should be completed by the end of May. New MCPs must quickly coordinate their outreach to providers and enrollees in the now much larger plan regions. New contracts are effective Jan. 1, 2013.
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