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Published: Wednesday, May 16, 2018 @ 12:13 PM
Ohio is overhauling the way Medicaid pays addiction treatment and mental health care and a state group says the new system could put some cash-strapped organizations out of business.
Ohio Medicaid has historically directly paid behavioral health providers, but starting July 1 the providers will negotiate with private companies like CareSource, which manage Medicaid plans on behalf of the state.
The new system will improve the quality of care while holding down costs, and is already leading to more efficiency, said Greg Moody, director of the Governor’s Office of Health Transformation.
But its been a bumpy transition so far as the state makes billing changes leading up to the July 1 transition, according to The Ohio Council of Behavioral Health Providers.
The changes come at a time when behavioral health providers are playing a critical role in responding to the opioid crisis, which contributed to a total 566 accidental overdoes deaths in Montgomery County last year.
The Ohio Council said its providers that depend on Medicaid are financially fragile and need more time to prepare for the new payment system, with many of the providers struggling with getting paid under the more complicated system with more rules to navigate to get approved for payment.
A new survey of Ohio Council member providers shows 56 percent have less than 60 days cash on hand with 37 percent having less than 30 days. Since the Jan. 1 changes, 59 percent of provider organizations reported dipping into their cash reserves, and about 35 percent of these providers had to draw down from a line of credit to support the changes, the same survey shows.
“While ultimately integration into managed care promises to be beneficial, that’s not true yet,” Lori Criss, CEO of the Ohio Council, said.
Payment delays and claim denials
One of the council’s concerns is that the Medicaid managed care companies will pay slower than when the providers directly dealt with the state, and those delays will harm providers, especially providers with tight budgets.
The state in January switched to new billing codes that the managed care insurers will be using, so instead of billing for all services under 17 codes they are now billing for 120 codes.
The Ohio Council said providers are not getting paid as quickly as they used to, as they struggle to submit claims under the more complex system.
Greg Moody, director of the Governor’s Office of Health Transformation, said the payments in the first quarter of 2018 were down 7 percent compared to the same time in 2017.
Moody said that some of the claims are being denied because the new system is better at catching inappropriate claims that the state shouldn’t be paying.
The states claims data also shows that by March, the number of rejected claims was down compared to January, which Moody said showed that providers were working through initial challenges and learning to bill under the new system.
Tom Otto, association CEO for TCN Behavioral Health Services, which has about 8,000 clients from Greene County and surrounding communities, said changes are bringing behavioral health care in line with other providers.
He said there had been some challenges earlier in the year with the billing changes, like learning to use the new system. He also said there are some limits to the new billing codes, like only getting reimbursed for the first hour of assessments when those typically run longer.
But Otto said overall that he anticipates TCN will perform well under the payment model that managed care insurance companies use based on measurements of the value of care.
“I’m actually excited that we have an opportunity to prove our treatment is effective,” Otto said.
Moody said delays in getting paid reflects the provider learning curve with the new codes, but don’t reflect an inherent problem in the design of the new system.
“What really we need to do is provide technical assistance to help providers get their claims in,” Moody said.
In the old system, Ohio Medicaid also paid the same amount for services no matter who was providing the service. Moody said the billing codes now let the state see who is providing the services and pay more for people with higher skill sets, for example reimbursing doctors more than registered nurses.
“For some of the smaller providers, this is a big change. And we acknowledged that and have tried to support them through this,” Moody said.
Sue McGatha, president of Samaritan Behavioral Health, said it was an investment to prepare staff on how to document services under the changes and they are still learning to trouble shoot glitches in getting paid.
“It took us the better part of the year to actually do all of the set up work and training for all of our staff, working with our IT vendor and our electronic health record to make all the changes necessary to be able to bill for all the new codes,” McGatha said.
Separate from the redesign, the state budget for Medicaid for fiscal year 2018-2019 budget reduced the Medicaid budget below the amount needed to run the program.
Ohio Medicaid is also facing a budget shortfall, so to balance its budget, in April the department delayed payments to providers by one week.
That saved the state $66 million this fiscal year, pushing all payments a week back so that one of the weeks is now pushed into the next fiscal year. But this has meant providers are now a week behind on getting paid.
Ohio Medicaid is still going to be close to hitting its budget and might delay payments again in June, said Moody.
Published: Friday, July 20, 2018 @ 4:23 PM
— Ohio Democrats gathered in front of Good Samaritan Hospital on Friday to advocate for Medicaid expansion support.
The Dayton hospital is poised to close 12:01 a.m. Monday, and the hospital’s emergency department has already closed.
Local Democratic candidates said erosion of Medicaid expansion could lead to more hospital closings as that burden of care covered under the state-federal insurance program instead becomes unpaid hospital bills and lost revenue.
Premier Health, which operates Good Samaritan, has said the hospital is closing because it isn’t sustainable to maintain two hospitals five miles from of each other when health care is shifting to outpatient settings and the population in Dayton is falling.
Premier did not endorse the event outside of the hospital.
Premier said in a statement following the event that the Dayton area is one of just a few large metropolitan areas in the United States that lack a public or university-operated hospital, which help cover the community cost of caring for Medicaid patients, and that combined with a “low per-capita level of local levy support for health services” underscores why area hospitals need Ohio’s Medicaid expansion to remain in place.
“However, Medicaid expansion was not a factor in the decision to close Good Samaritan Hospital’s main campus on Philadelphia Drive. Instead, Premier Health is doing its part to address the excess number of inpatient beds across the entire Dayton region,” Premier stated.
But Ohio Democrats still highlighted it Friday as a symbol of how curtailed Medicaid expansion could harm hospitals because they said it shows an example of a hospital closing and how that affects a community.
David Pepper, chairman of the Ohio Democratic Party, said Good Samaritan is “symbolic, unfortunately, of what might happen if we don’t get it right in November.”
“This November we have on the ballot a group of candidates like the candidates here today who are fighting for things like Medicaid expansion, they are fighting for people with pre-existing conditions,” he said. “On the other side we have opponents who have voted again and again against Medicaid expansion.”
Besides Pepper, those in attendance included Ohio Senate District 5 candidate Paul Bradley, Ohio House District 40 candidate Ryan Rebecca Taylor, Ohio House District 41 candidate and Dayton Public Schools Board Vice President John McManus and Ohio House District 42 candidate Zach Dickerson.
Mike DeWine, Republican candidate for Ohio governor, recently said he would support keeping Medicaid expansion but would want reforms like work requirements.
As Ohio Attorney General, DeWine had previously challenged the Affordable Care Act and its provisions, including Medicaid expansion. His Democratic opponent, Richard Cordray, supports Medicaid expansion.
Published: Wednesday, July 18, 2018 @ 10:03 AM
— The magical world of Harry Potter is coming to Ohio.
Ohio-Made Getaways is hosting “A Magical Getaway: Celebrating Potter Palooza” in Lancaster on Aug. 3 and 4. Fairfield County District Library’s community-wide celebration of 20 years of Harry Potter is a two-day getaway with plenty of fun activities for wizards and muggles of all ages.
Lancaster is less than two hours from Dayton. Guests pick up a Marauder’s Map at the visitors center at 205 W. Main St. The festival includes:
• A wizarding costume contest at the library on 2 p.m. at 219 N. Broad St.
• Wizard Rock Band Tonks & the Aurors concert at 3 p.m. at the Downtown Bandstand at 3 p.m. on Friday
• Quidditch Demonstration at Rising Park at 203 E. Fair Ave. at 10 a.m. on Saturday
• Hogwarts Herbology class, where you will create and tend to your very own magical mandrake plant to take home and watch grow
• Visit Ollivander’s Wand Shop at the First Presbyterian Church (222 N. Broad St.)
• Art and Clay offers a“Mischief Managed” dinner plate painting project with a fun and simple design
• Two Broke Artists lead a Harry Potter Youth Painting Class.
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Published: Friday, July 20, 2018 @ 8:17 AM
— A retailer at The Greene Town Center alerted customers about an issue with transactions being processed correctly at its store.
Jake’s Toggery, a clothing retailer, sent an email to customers alerting them about an issue with their credit card processor. NCR Merchant Solutions told the retailer that transactions made at two locations of Jake’s Toggery did not process correctly.
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The two impacted stores are Jake’s Toggery at The Greene in Beavercreek and Jake’s Toggery Polaris in Columbus. If a customer made a purchase at one of these store locations from June 21 to July 17, the purchase has not shown up on their credit card statement. The retailer said NCR Merchant Solutions is working to reprocess each affected transactions, which should hit accounts soon, according to the email.
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“We recognize how concerning seeing an unrecognized or forgotten transaction from several weeks ago might be, but please rest assured that our servers and systems are secure, and that at no time would any of your information have been compromised,” the email stated.
NCR Merchant Solutions has issued the following statement: “We sincerely apologize for this issue and are hoping to get all corrected soon.”
Jake’s Toggery also has a location at the Liberty Center in Liberty Twp.
FIVE FAST READS
Published: Friday, July 20, 2018 @ 10:30 AM
Dayton — So far, most public comments have favored building a traffic roundabout at the busy Mad River/Alex-Bell roads intersection, a roundabout that Montgomery County Engineer Paul Gruner said would do away with the thousand-foot backups that stymie the current four-way-stop intersection at the busiest hours.
“We’re reducing the 1,000-foot backups to nothing essentially at the peak hours,” Gruner told a I-70/75 Economic Development Association breakfast meeting at Sinclair Community College Friday.
People may comment on the roundabout proposal until July 31. A comment form on the idea can be found at the Montgomery County engineer’s office web site. (Go to www.mcohio.org/government/elected_officials/engineer/Alex_Bell_Mad_River_Notice.php.)
Gruner joined Randy Chevalley, Ohio Department of Transportation District 7 director, in talking about upcoming area transportation projects Friday, including the plan to add a lane on Interstate 70 from Ohio 68 to Ohio 72 between Dayton and Springfield, perhaps the regional road project that will affect the greatest number of motorists.
Some 65,000 to 70,000 motorists use that stretch of I-70 daily, Scott LeBlanc, ODOT District 7 construction engineer, has told this news outlet.
The start for the $43 million I-70 project is only days away, slated to begin Aug. 9 with a September 2021 completion date. Traffic is to be maintained on two lanes in each direction during construction.
No final decision has been made yet on the roundabout, Gruner said after his public remarks to the development association. He noted that the project will require federal funding.
He estimated that the project, if approved, wouldn’t be completed until about the year 2012. But right now, Gruner and his staff are leaning toward that option.
“We had a consultant do a study which said a roundabout is the best solution,” Gruner said. “So far, the comments are running about three out of four in favor of the roundabout. Very few people are against doing anything.”
The estimated cost for the project is about $1.5 million at this point, he said.