Where can I find information about Ohio Medicaid specialized recovery services?
Information may also be found on the Ohio Department of Medicaid website by following the Specialized Recovery Services page.
Is there a 1115 waiver for substance use disorder in Ohio?
OHIO MEDICAID 1115 DEMONSTRATION PROPOSAL FOR SUBSTANCE USE DISORDER TREATMENT I. SUMMARY The Ohio Department of Medicaid (ODM) is requesting an 1115 Demonstration Waiver for substance use disorder (SUD) inpatient and residential treatment in managed care and fee-for-service (FFS) for adults and children.
Where do I submit public comments to Ohio Department of Medicaid?
– Ohio provided a US Postal Service address for submission of public comments: Substance Use Disorder Treatment Demonstration Waiver, Bureau of Health Plan Policy, Ohio Department of Medicaid, 50 W. Town Street, Suite 400, Columbus, OH 43215. A total of 19 comments were received via this method by the November 25, 2018 deadline. Courier/Drop Off
How has the number of individuals receiving SUD treatment changed in Ohio?
The number of individuals receiving SUD treatment continues to grow. Ohio has tracked the increased capacity in the system through the increased number of individuals in treatment and the improved treatment rates of this population (i.e., increase SUD services penetration rate). See table below:
What does Medicaid cover in Ohio?
Medicaid provides primary and acute care services through a fee-for-service system or managed care plans. Both delivery systems provide all medically necessary primary care, specialty and emergency care and preventive services.
What is not covered by Medicaid?
Medicaid is not required to provide coverage for private nursing or for caregiving services provided by a household member. Things like bandages, adult diapers and other disposables are also not usually covered, and neither is cosmetic surgery or other elective procedures.
What is covered by Medicaid?
Mandatory benefits include services including inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.
What are waiver services in Ohio?
Waiver Services. Medicaid waivers allow individuals with disabilities and chronic conditions to receive care in their homes and communities rather than in long-term care facilities, hospitals or intermediate care facilities.
Does Medicaid cover dental for adults 2021?
We are excited to announce that starting July 1, 2021, adults receiving full Medicaid benefits are eligible for comprehensive dental care, giving them access to more services and provider choices through DentaQuest.
Does Medicaid cover surgery?
Medicaid does cover surgery as long as the procedure is ordered by a Medicaid-approved physician and is deemed medically necessary. Additionally, the facility providing the surgery must be approved by Medicaid barring emergency surgery to preserve life.
Does Medicaid cover braces?
The answer is yes! If braces are deemed medically necessary for your child, Medicaid can assist in getting them.
Who pays for Medicaid?
The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP).
Can I use my Medicaid in a different state?
Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your coverage when you're temporarily visiting another state, unless you need emergency health care.
How do I get a Medicaid waiver in Ohio?
To request an Ohio Home Care Waiver, complete the ODM 2399 waiver application and submit it to your local county department of job and family services. You may also need to complete a Medicaid application if you do not currently receive Medicaid coverage.
What is a Level 1 waiver in Ohio?
The Level One Waiver is a Medicaid waiver for people with developmental disabilities who meet certain eligibility criteria. The waiver allows people to stay in their homes and get support, rather than require them to live in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).
What is the monthly income limit for Medicaid in Ohio?
If a non-applicant's monthly income is under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to $2,288.75.
What are the eligibility criteria for SRS?
There are several eligibility factors that an individual must meet in order to qualify for SRS, including having a qualifying severe and persistent mental illness (SPMI) or a qualifying diagnosed chronic condition (DCC). The individual must also meet the definition of disability as used by the Social Security Administration, with certain exceptions.
What is SRS in medical terms?
SRS is for individuals diagnosed with severe and persistent mental illness (SPMI) and/or certain diagnosed chronic conditions (DCC), or who are active on the solid organ or soft tissue transplant waiting list. To be eligible for SRS, the following criteria must also be met: You have income below $2,349 per month ($28,188 per year) ...
What is peer support?
Peer recovery supporters are people who use their own experiences with mental health and substance. use disorders to help individuals reach their recovery goals. Goals are included in a care plan designed. by the individual based on his or her preferences and availability of community and natural supports.
What is supported employment?
Supported employment services can help individuals find a job. A supported employment worker will. evaluate an individual’s interests, skills, experience, and goals as it relates to employment goals. IPS. programs also provide ongoing support to help individuals successfully maintain employment. A job can.
Budget Impact
Ohio Medicaid proposes investing $7.51 million ($1.88 million state GRF) in an 1115 waiver for substance use disorder services that will require implementation of a new Behavioral Health Care Coordination model with an investment of $338 million ($50.6 million state GRF) over the biennium.
Background
Ohio’s rates of both substance use disorders and mental health disorders are higher than national averages across nearly all age groups.
Policy Proposal
Ohio Medicaid is collaborating with the RecoveryOhio initiative and other state and local entities to strengthen access to care and improve outcomes for adults and children who need behavioral health services. Medicaid is proposing the following budget initiatives to work toward these aims.
When will Ohio Medicaid prior authorization for SUD be required?
The State will clarify that ASAM will be utilized for prior authorization for partial hospitalization and all residential levels of care and utilization review in Ohio Medicaid for all levels of care for FFS and plans after July 1, 2019.
How does Ohio prevent drug overdoses?
Ohio has taken steps to prevent drug overdose deaths through the expanded availability and use of the opiate overdose reversal drug Naloxone. One of the most effective steps for expanding coverage included permitting pharmacists to dispense Naloxone without a prescription in 2015. To assist pharmacies, the State of Ohio Board of Pharmacy developed a dedicated web page, www.pharmacy.ohio.gov/naloxone, which features helpful resources including a guidance document, sample protocol, and a listing of all participating pharmacies. The Pharmacy Board also offers printed, no-cost patient educational materials to any participating pharmacy. By 2017, more than 1,600 Ohio pharmacies in 87 counties offer Naloxone without a prescription.
What is the OAC code for SUD?
Ohio Administrative Code (OAC) 5160-27-09 describes SUD treatment services provided to all individuals in Medicaid. This regulation requires the use of the ASAM treatment criteria for addictive, substance related and co-occurring conditions for admission, continued stay, discharge or referral to each LOC. All plans are required to follow OAC 5160-27-09 in providing BH services under the plan provider agreement.8
How does ODM work in Ohio?
ODM approaches care coordination by promoting a population health management approach as well as other reforms to create a system to better care for all individuals in Medicaid including those with SUD diagnoses. Specifically, ODM identifies and monitors individual patients within specific groups such as individuals with BH diagnosis. Data are used to risk stratify Ohio individuals in Medicaid and group them into population streams, one of which is BH. Strategies specific to risk levels and population streams are then developed by ODM and contracted managed care plan partners to improve patient outcomes and experience of care. Value-based purchasing strategies further enhance the promotion of evidence-based and comprehensive care for patients with
How does Ohio combat opiate abuse?
GCOAT planned to save lives by tackling the oversupply of prescription opioids, preventing prescription drug abuse before it starts, treating those who succumb to drug addiction and utilizing naloxone to reverse drug overdoses. Ohio is combating drug abuse through many initiatives on several fronts at the state and local levels involving law enforcement, public health, addiction and treatment professionals, health care providers, educators, parents and many others. New initiatives were developed, and then launched in 2013 or later; it will take some time for their full impact to be reflected in reducing the number of drug overdose deaths. For more information, visit http://mha.ohio.gov/gcoat. See Attachment B for an overview of the actions taken by the State to improve access to SUD services and promote quality and safety standards.
What is Medicaid 1115 waiver?
The Ohio Department of Medicaid (ODM) is requesting an 1115 Demonstration Waiver for substance use disorder (SUD) inpatient and residential treatment in managed care and fee-for-service (FFS) for adults and children. Ohio also requests this Demonstration to ensure a complete American Society of Addiction Medicine (ASAM) level of care (LOCs) array is available as part of an essential continuum of care for Medicaid-enrolled individuals with opioid or other SUDs. This Demonstration waiver is requested to be effective immediately upon approval to use in Institutions for Mental Diseases (IMDs) as a Medicaid-covered setting.
When is the next milestone for FFS?
Milestone 2 July 1, 2019 Require the FFS delivery system and “the plans” including both MyCare Ohio Plans (MCOP) and Managed Care Plans (MCP) to use ASAM standards for utilization review at all LOC. Milestone 2 July 1, 2019 Review plan policies for utilization review and prior authorization for compliance.
When was the Ohio SUD waiver approved?
On September 24th, 2019, The Centers for Medicare and Medicaid Services (CMS) approved Ohio’s substance use disorder (SUD) demonstration waiver to support a comprehensive continuum of care for Medicaid-enrolled individuals with an opioid use disorder (OUD) or other SUDs.
How long is the Ohio SUD demonstration period?
During the five-year demonstration period, Ohio seeks to: Increase rates of identification, initiation, and engagement in treatment for SUD. Increase adherence to and retention in treatment. Reduce overdose deaths, particularly those due to opioids.
How much can you retain for Medicaid in Ohio?
First the good news: an individual applying for Medicaid under the redesign can retain resources up to $2000, a $500 increase from the previous limit of $1500.
How long does a residence have to be sold for Medicaid?
For Medicaid applicants without a community spouse, the residence was exempt from being counted for thirteen months. After thirteen months , the residence had to be sold and the proceeds of the sale had to be "spent down" for care until the applicant met Medicaid's asset eligibility limit.
Does Ohio have Medicaid for house exemption?
Ohio Medicaid Changes Rules Regarding House Exemption. Some recent changes to the Ohio Medicaid program may have escaped your notice at the time they took effect, but you should take notice if you or a loved one receives Medicaid in an Ohio nursing home or assisted living facility.
Can you transfer a home to a sibling with Medicaid?
If you are looking to preserve real estate or its value for your family, including adult children, there are some options available to you. If you do not have a spouse, you may be able to transfer the home to a sibling who has an equity interest in the property.
Is a primary residence countable for Medicaid?
As before the change in the law, the primary residence is still exempt from being considered a "countable asset" for Medicaid when a recipient receiving long-term care is married and the other spouse (also known as the "community spouse") remains in the home.
