11/17/2022

ODM postpones Next Generation managed care plans until February 1, 2023

The Ohio Department of Medicaid (ODM) announced on Tuesday that it will not implement the new Next Generation managed care plans and the full Ohio Medicaid Enterprise System (OMES) launch on December 1. As a reminder, Medicaid “Next Generation” is a three-phase roll out of transformative changes to the Ohio Medicaid program. The first phase was the launch of the OhioRISE program, a single plan for multi-system youth in the Medicaid program. The second phase launched October 1 with the “go live” of a single statewide pharmacy benefits manager (PBM) and the launch of the Provider Network Management (PNM) module, one component of OMES that includes centralized provider credentialing and eventually will serve as the primary portal for claims submission and other reporting functions. LeadingAge Ohio has previously reported on the rocky rollout of PNM, and many providers still experiencing challenges with the system. 

Originally, ODM had targeted December 1 for the “go live” of phase III, which included the phase-out of MITS, the launch of a centralized fiscal intermediary, as well as the transition to Ohio’s newly procured managed care programs (not including the MyCare plans / program). 

The new lineup for implementation is as follows:

• On February 1, 2023, ODM will launch the Next Generation managed care plans and program requirements, including improvements that will support members in accessing the healthcare services and supports. ODM will also implement the new Electronic Data Interchange (EDI), increasing transparency and visibility of member care and services.
• Subsequently, ODM will fully launch OMES modules to provide streamlined processes for claims, prior authorizations, and other administrative tasks for providers.

ODM states its focus continues to be centered on "implementing new components and improvements as they are fully ready to support achieving its mission" and "actively seeking input from stakeholders and conducting testing of all systems."

Over the past year, ODM has prepared for and launched components of the Next Generation Ohio Medicaid program. On July 1, ODM implemented OhioRISE (Resilience through Integrated Systems and Excellence) and on October 1, ODM implemented the Single Pharmacy Benefit Manager (SPBM) and Centralized Credentialing for providers. 

What does this mean for providers?

Providers should continue conducting business as usual today and after December 1 – including the processes, procedures and systems used today to submit claims, prior authorizations and complete other administrative functions. ODM will provide more information about the upcoming implementation for members and providers in the coming weeks.

Questions related to this may be sent to Susan Wallace at swallace@leadingageohio.org or Anne Shelley at ashelley@leadingageohio.org.