ODM policy guidance for managed care organizations regarding: behavioral health, pharmacy, dental, hospital services, long term care, provider enrollment, laboratory services, substance use disorder treatment, file specifications, EPSDT, EVV, MyCare Ohio, hospice, medical necessity and prior authorization limitations, episodes of care, and more.
2022
- Zynteglo Coverage Memo
- Skysona Coverage Memo
- Zolgensma Coverage Memo
- Provider Directory Source of Truth
- Credentialing for New MCEs
- Coverage of Chiropractor E&M Services
- Notice of Policy Rescission
- Medicaid Addendum-Removing Attachment B
- Unified PDL Adherence Methodology and Compliance for MCPs
- Revised-Provider Revalidation Waiver
2021
- Provider Revalidation Waiver
- Hospital Admitting Privileges and Network Adequacy Requirements
- Guidance Document for PCSA Medication Report
- PCSA Medication Report FAQ
- Senate Bill 263 and 340B Providers
- FAQ: Medicaid Managed Care and Fee for Service Dental Services
- Unified PDL Adherence Methodology and Compliance for MCPs
2020
- Pharmacists as Providers Guidance Memo for Managed Care Organizations
- Dental Services and Encounter Submissions
- Medicaid Enrollment of Group Practices
- Provider Enrollment, Rendering NPI, and Ordering, Referring, and Prescribing (ORP)
- July 2020 Provider Agreement Clarification Memo
- Hospital Inpatient Readmission Policy
- Use of ASAM Criteria in Hospital Settings
- Medical Necessity Reviews for Non-Covered Services and Prior Authorization Limitations
- Nursing Facility Provider Minimum Payment Memo
- BH Grievance Reporting
- SUD Treatment Documentation Guidance
2019
- Qualified Laboratory Requirements in July 2019 Provider Agreements
- Coverage of Insulin Pumps
- Episode of Care Program Update
- Covered Outpatient Drug Guidance
- Minimum Standards for SUPPORT Act Compliance
- Managed Care & HOME Choice Guidance
- Hospice Services in Nursing Facility Policy Clarifications
- Incident Management Timeframes and Documentation Requirements
- MyCare Ohio Report Submission Changes – Incident Management, Health & Welfare, and Self-Direction
- Electronic Visit Verification (EVV) Pay and Post
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program Requirements
- Managed Care Plan Nursing Facility Disenrollment Requests
- Prompt Pay Requirements for Behavioral Health Claims
- Urine Drug Screen Guidance
- Statewide Hepatitis A Outbreak - Vaccine Coverage Mandate
- BHCC Delayed Implementation
- Third Party Liability and the Bipartisan Budget Act of 2018
- Maternal Opioid Misuse (MOM) Model Memo
- Clarifications Related to Home Delivered Meals Waiver Service
- Increasing Access to Medication Assisted Treatment (MAT)
2018
- Omnipod Coverage
- NF LOC Waiver Alignment Update
- Third Party Liability Requirements Related to Recovery Timeframes
- MyCare Ohio Home Modification Waiver Service
- Waiver Service Provider Signature Requirement
- Lab Contract and SUD Treatment Providers
- SRSP and Managed Care Enrollment Update
- Additional Information and Clarification for Provider Agreement Updates July 2018
- July 2018 Provider Agreement Guidance with CSP Attachments
- Letter to HealthPlan Data Solutions, LLC
- Addressing Patient Liability Discrepancies
- Letter to Managed Care Plans regarding PBM analysis
- Nursing Facility Encounter Guidance
2017
- Enhanced Maternal and Reproductive Care File Specifications
- Communication for Medicaid and Managed Care Providers: New Populations Moving to Managed Care
2016
- Provision of Enhanced Maternal Care Services
- Managed Care Enrollment for Children in Custody and Adopted Children Webinar
- 2016/2017 New Managed Care Populations
2015
2014