breaking news


Ohio Medicaid overhauling how it pays for addiction, mental health care

Published: Wednesday, May 16, 2018 @ 12:13 PM


            KATIE WEDELL/STAFF
KATIE WEDELL/STAFF

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.

RELATED: Local doctor named president of medical lobbying group

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.

MORE: Did drug distributors contribute to opioid crisis? Yes, says local exec.

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.

Related: Ohio launches campaign to prevent youth suicide

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.

RELATED: State’s record for enforcing insurance mandate questioned

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.

Medicaid budget

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.

Criss, of the Ohio Council, said this delay in payment makes providers financially vulnerable and less able to handle the changes of the redesign.

Trending - Most Read Stories

Kroger buys Home Chef in deal worth $700M; meal kits will be sold in stores, online

Published: Wednesday, May 23, 2018 @ 5:01 PM

Greg Gilbert/The Seattle Times
Greg Gilbert/The Seattle Times

Kroger Co. is buying Home Chef, the country’s largest private meal kit company, in deal that could reach $700 million, according to the Cincinnati-based grocery chain.

The initial transaction price is $200 million and future payments of up to $500 million over five years are contingent on achieving certain sales goals, the company said.

PHOTOS: Take an early look at Macy’s Backstage at the Dayton Mall

The pending merger comes on the heels of Home Chef’s 150 percent growth in 2017, $250 million in revenue, and two profitable quarters, according to Kroger.

“Customers want convenience, simplicity and a personalized food experience. Bringing Home Chef’s innovative and exciting products and services to Kroger’s customers will help make meal planning even easier and mealtime more delicious,” said Yael Cosset, Kroger’s chief digital officer. “This merger will introduce Kroger’s 60 million shoppers to Home Chef, enhance our ship-to-home and subscription capabilities, and contribute to Restock Kroger.”

Home Chef employs approximately 1,000 employees, is headquartered in downtown Chicago, and operates three distribution centers in Chicago, Atlanta and San Bernardino. Home Chef’s distribution centers reach 98 percent of all continental U.S. households within a two-day delivery window, according to the company.

“We’ve long believed that the future of our industry is omni-channel and bigger than just meal kits sold online. We want to be where our customers are and want to help make cooking at home easier, more accessible and even more enjoyable,” said Pat Vihtelic, Home Chef’s founder and CEO. “

After the deal closes, Home Chef will operate as a subsidiary of Kroger Co., maintain its e-commerce business on homechef.com, and assume responsibility for Kroger’s meal solutions portfolio. The company will continue to operate its offices and facilities.

Following closing, Kroger will make Home Chef meal kits available to Kroger shoppers, both in stores and online.

FIVE FAST READS

RELATED: Ohio colleges taking steps to avoid unchecked sex abuse cases

PHOTOS: Victorian farmhouse with wine cellar, party barn on sale in Troy

• Body found in pond at an Ohio community college

• Local college took on #MeToo decades before a movement went mainstream

Trending - Most Read Stories

5 amazing flight deals we found at local airports for summer travel

Published: Monday, May 21, 2018 @ 8:16 AM

Ready for a vacation? Follow Clark Howard's method to find the best fares!

It’s time to book your next vacation.

Discount airlines flooded regional airports with cheap, new flights to destinations across the world. WOWair, Frontier Airlines and Allegiant Air added new flights in Columbus, Cincinnati and Dayton — lowering airfare for eager travelers in the region. There are plenty of cheap flight options to take advantage of this summer.

» WHAT YOU NEED TO KNOW: How to book cheap flights

Here are five of the best flight deals this news organization found at local airports:

1. Head to the beach from Dayton 

The ocean is calling. Book a ticket from the Dayton International Airport to Punta Gorda Airport in Florida for a week-long beach vacation. From Monday, June 18 to Monday, June 25, travelers can pay as letter as $185 round-trip for a ticket on Allegiant Air. Allegiant flights to Punta Gorda are available on Mondays and Fridays.

» Your next weekend trip: 20 things to do, see, eat in Cincinnati

2. Jet off to Iceland for less than $300

It’s cheaper than ever to hitch a flight overseas from a local airport. Icelandic discount airline WOW air introduced service at the Cincinnati/Northern Kentucky International Airport earlier this month. Leave the Cincinnati airport on July 4 at 12:50 a.m. Your WOW basic ticket to Reykjavik, Iceland will cost you $109.99. You’ll leave Iceland on Wednesday, July 25. Your ticket home will cost you $159.99. You spend a total of $270 on your roundtrip travel.

 

3. Spend some time in the Lone Star State 

Frontier is offering one-way fare to Austin, Texas from Columbus for as low as $59 if you purchase the tickets by May 31. The deal is valid on tickets for Tuesdays and Wednesdays. Frontier offers best deals on their website every week.

4. Bon voyage! Paris is waiting for you 

You can actually afford international travel if you look for the right deals. Head off to Paris from Cincinnati with WOW air. You can leave July 30 and return Aug. 13. Your roundtrip fare could be as cheap as $610. WOW air fare varies by date so make sure to shop around to get the best deal.

» TRENDING: Meghan Markle has an extraordinary connection to Ohio

5. Go to Myrtle Beach for less than $100 

Fly from the Dayton International Airport to Myrtle Beach for as low as $100 roundtrip in July. Allegiant serves several cities from Dayton including: Daytona Beach, Orlando and Tampa, among others.

FIVE FAST READS

• With a harsh hurricane season expected, how do storms get named?

• Salmonella outbreak: 5 times food-borne illnesses wreaked havoc in Ohio

• This $2 million Warren County estate is a rural paradise with a resort-style pool

• 15 memories, moments at Elder-Beerman that influenced your lives

Trending - Most Read Stories

The historic Golden Lamb is getting some updates and renovations. Here’s what’s happening.

Published: Wednesday, May 23, 2018 @ 2:43 PM


            The Golden Lamb in Lebanon. Photographed Sept. 2016 LISA POWELL / STAFF
The Golden Lamb in Lebanon. Photographed Sept. 2016 LISA POWELL / STAFF

The Golden Lamb in Lebanon is beginning renovations on one of its four first-floor dining rooms and kitchen, one of several projects happening at the historic facility.

In addition, the Golden Lamb completed work on the General Grant Suite, updated the Henry Clay private dining room, refurbished third- and fourth-floor hotel corridors and commissioned two works by artists Ursula Roma and Suzanne Fisher that are now on display.

MORE: Then and now at historic Lebanon inn

Renovations for the Charles Dickens dining room are to be completed by early July.

The Golden Lamb also anticipates renovations to two other public dining rooms and the Black Horse Tavern.

For more information, visit www.goldenlamb.com or call 513-932-5065.

Trending - Most Read Stories

937 filling up: New phone area code coming to our area

Published: Wednesday, May 23, 2018 @ 2:26 PM

This is what telephones used to look like: Studio shot of an old rotary phone. FILE
This is what telephones used to look like: Studio shot of an old rotary phone. FILE

Get ready for a new telephone area code in Southwestern Ohio.

The Public Utilities Commission of Ohio today approved a plan to overlay a new area code over the existing 937 area code area.

Instead of dividing the existing 937 code geographic area, the “overlay” approach will allow the new code to go to new subscribers or new phone lines. 

The 937 area code is expected to run out of available phone numbers in the third quarter of 2020, the PUCO said. All current 937 area code subscribers will continue to maintain their current numbers and 937 area code.

 

MORESears to close 40 locations. Is the end near? 

The new number will affect new phone subscribers, and those trying to contact them.

“While we are still years away from the projected exhaust date, it’s important for the telecom industry to begin planning now so that the roll out of a new area code can go as smoothly and seamlessly as possible, just like previous area code additions,” PUCO Chairman Asim Z. Haque said in a statement.

The PUCO directed the telecommunications industry to file an implementation and communications plan. The plans should indicate when the overlay will happen and how companies will notify customers of the change.

On implementation of the new code, all new phone subscribers will be assigned the new yet-to-be-determined area code.

MORECenterville-area restaurant property sold 

Plus, all local calls will require dialing the full 10-digit phone number in order to complete local calls.

The North American Numbering Plan Administrator will assign the new, yet-to-be-determined area code to co-exist with the existing geographical boundaries of the 937 area code.

A copy of today’s PUCO finding and order is available at www.PUCO.ohio.gov, click on the link to Docketing Information System and enter the case number 17-2329-TP-COI.

Trending - Most Read Stories