Complete Story


Must Read: ODM Provider Association Meeting Yields Multiple Action Items

Last week LeadingAge Ohio participated in the monthly Provider Association meeting with Ohio Department of Medicaid (ODM).  Members are encouraged to skim the listing of topics below for items that are of interest, as may some require action. As always, feel free to reach out to LeadingAge Ohio’s Stephanie DeWees ( or Susan Wallace ( directly with questions pertaining to any of these items, or to elevate a question to ODM.

Authorized rep challenges. ODM stated they are aware that not all authorized reps are getting notified of changes as they should.  ODM believes that this oversight is now fixed (i.e. so that each and every authorized rep is notified when needed), but if issues continue, providers should reach out immediately to ODM.

Auto-disenrollment process.  ODM stated that submitting an individual’s renewal application will remove the individual from the county’s customer reporting page.  This removal takes the individual out of the auto-disenrollment and provides time to obtain all necessary renewal paperwork. The due date of the form is not the same date as the auto-disenrollment. This due date is the date of when the form needs submitted to prevent auto-disenrollment.

March 31 Cost Report Due Date. Cost reports are due 90 days from year-end.  In non-leap years this due date is March 31. In a leap year, such as 2020, this would move the day up to March 30, but ODM has extended the due date to March 31.

Hospice Direct Billing complaints. While the process of hospice entities participating in direct billing (initiated in 2019) has created issues for some providers, ODM has not seen an increase in complaints. ODM reminds providers to submit complaints on the designated OH Medicaid Managed Care Provider Complaint Form as this will prompt ODM to look into the specific issue.

Caresource pre-payment medical review instituted. ODM has been notified that Caresource will be implementing a pre-payment medical review (this was communicated in the Caresource policy update bulletin).

Submit MyCare complaints. ODM shared that it is important for providers to submit complaints regarding MyCare managed care companies by submitting an OH Medicaid Managed Care Provider Complaint Form.  ODM collects these reports and analyzes them for recurring issues.  If a plan has five or more providers with a specific issue or there is reason to believe there is a systemic issue, then the plan must submit a CPSE – claims payment system error report (CPSE) to ODM. The plan is then to provide ODM information on the complaint issue, when it occurred, how the plan anticipates addressing the issue, and when it will be fixed.

Patient Liability issues studied.  The patient liability rules are being opened up sooner than the 5-year rule review time period due to ongoing issues. ODM is working with the Provider Associations to study the issues in more depth.

Medicaid SNF Payment Redesign. There will be a PDPM workgroup developed this spring to provide input into ODM’s work with Myers & Stauffer on development of the Optional State Assessment (OSA).  A detailed timeline has been developed to ensure that Ohio is positioned to meet CMS’ timeline.

Resident Satisfaction Survey results impact NF rates. Resident satisfaction survey results impact the July 1 NF rates, but if the most recent survey results are not available, ODM will follow the statute language which says to use most recent “available data”, which would be 2017 resident data;

Next round of Exception Reviews to begin.  The next round of exception reviews will begin in the next few weeks. As before, providers will be selected based on a risk assessment algorithm developed by the evaluation firm Myers & Stauffer. Over the next 3 months approximately 50 facilities will be selected for the reviews. The last round of exception reviews resulted in 15 failed providers for a total of $862,000 in reduced direct care for the January 1, 2020-June 30, 2020 rate.  There were no LeadingAge Ohio members within the list of failed providers. 

Post-payment Reviews. The FY 2017 & 2018 post payment review communications will be conducted electronically through a secure system. The initial communication will be a letter and ongoing communication will occur via email. ODM will be updating the response form to make it clear to providers the requirement of submitting the response form within 30 days. The 30-day timeframe does pertain to the supporting documentation. 

LeadingAge Ohio meets with ODM’s staff on a monthly basis to cover updates and relay information heard from providers. LeadingAge Ohio members are encouraged to send questions or issues they’d like addressed to Susa Wallace, Director of Government Relations & Public Affairs to

Printer-Friendly Version

Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.