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Community Medicaid

Ohio’s Community Medicaid mental health program is managed by the Ohio Department of Mental Health (ODMH) Office of Medicaid. While the Ohio Department of Job and Family Services offers assistance to consumers applying for Medicaid benefits, the ODMH Office of Medicaid works with county mental health boards to assure that state Medicaid requirements are met by those providing mental health services to consumers. The Office of Medicaid staff strives to better serve the mental health community by balancing the needs of Ohio’s publicly funded behavioral health system with federal and state payer requirements.

Medicaid Information Technology System (MITS) Updates

Important system upgrades critical to meeting the future needs for Ohio's Medicaid program have launched through the Ohio Department of Job and Family Services. Two updates specifically for Ohio's Behavioral Health Providers have been issued via ODMH listservs.

MITS Update Aug. 10, 2011. Read the update for details on how to stay informed during the MITS system roll-out.
MITS Update Aug. 16, 2011. Read the update on issues regarding denied claims.

Updates

• MACSIS Updates
• Medicaid Updates

SFY 2011 Community Medicaid Rate Information

• ODMH Actual Uniform Cost Report (DMH-FIS-047)
• Medicaid Fee Schedule Implementation 10-04-2010
  • Fee Schedule Service Array - ODMH
  • Fee Schedule Service Array - ODADAS

Training Materials

• Health Care Excel Prior Auth Training Presentation October-November 2011
• ODMH Medicaid Benefits Training Presentation October-November 2011
• ODMH Prior Authorization Training Presentation October-November 2011
• ODMH Web Portal Training Presentation October-November 2011
• Mental Health Benefits Training presentation, June 2011, Revised July 5, 2011
  Disclaimer: Please note that certain slides have been revised from the original version presented during the 5 regional training sessions held in June, 2011. The slides have been modified to reflect the status of the current proposals as of July 5, 2011 and are footnoted with the following: "Revised, July 5, 2011". In addition, the utilization management limits described in the training presentation are to be considered proposed, as they are not currently in effect.
  Please refer to the communication dated June 30, 2011 from ODMH Director Tracy J. Plouck for the current status of all of the cost containment initiatives described in the training presentation.
• Mental Health Benefits Training Invitation from Director Plouck, May 2011
• Progress Note Examples and Documentation & Medical Necessity Training Materials
• FAQs about the ODMH Community Audit Program
• 3/30/06 Memo for Implementation of OAC rule 5101 : 3-27-05 Provisions Related to Partial Hospitalization Services 
• Medicaid Rate Setting Reimbursement & Reconciliation Rules Training, January 2006 
• Uniform Cost Report Rules and Training Materials, January 2005

Prior Authorization Exemption for Psychiatrists

The documents in this section relate to the Ohio Department of Job and Family Services, Office of Ohio Health Plans revised policy for covering certain second generation anti-psychotic medications prescribed to aged, blind or disabled clients enrolled in Medicaid managed care plans. Under the revised policy, psychiatrists contracting with managed care plans or working through a community mental health center (CMHC) may be exempt from prior authorization requirements for current and future second generation anti-psychotics without an available generic, bio-equivalent or metabolite.

• Psychiatrist Prior Authorization Exemption for 2nd Generation Antiphyschotic Drugs for Ohio Medicaid Managed Care Plans (MCPs)
• Master CMHC Phychiatrist Data

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National Provider Identifier (NPI) for Crossover & Risperdal

The National Provider Identifier (NPI) for Crossover & Risperdal documents in this section relate to the process that community mental health agencies must follow to ensure proper Medicare/Medicaid crossover payments and risperdal payments. The process is due to the implementation of the National Provider Identifier (NPI) system. The NPI is a unique health provider identifier on standard electronic health care transactions. It simplifies exchange of health care data by eliminating the need for health care providers to use different identification numbers to identify them when conducting standard transactions with multiple health plans.

• Urgent: National Provider Identifier (NPI) Instructions for Medicare/Medicaid Crossover Payments & Risperdal Payments

Certified Public Expenditure Process

This process is used by boards to demonstrate the source of funds (Medicaid expenditures) used to pay for Medicaid-covered behavioral health services delivered by providers of alcohol and other drug treatment and/or mental health services.

• ODADAS and ODMH Web-Based Modified Certified Public Expenditure (CPE) Application Update and Invitation 
• State Fiscal Year (SFY) 2009 Community Medicaid Financing Information (large file)
• Forthcoming Proposed Changes for Behavioral Health in Ohio from Ohio Department of Job & Family Services, Ohio Department of Mental Health and Ohio Department of Drug and Alcohol Services 
• Behavioral Health System Reform April 2008 Update

Medicaid Agreements for FY 08 and FY 09

• Ohio Department of Job & Family Services (ODJFS) Medicaid Provider Agreement Letter
• Community Medicaid Agreements and Board/Agency List Letter 
• Community Medicaid Services Agreement Between The Ohio Department of Mental Health and ADAMH/CMH Boards 
• Community Medicaid Services Agreement Between ADAMH/CMH Boards and Community Mental Health Agencies

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Board/Agency Exhibits

• FY12 Interagency Agreement between ODJFS & ODMH A-123-07-0279
• FY12 Interagency Agreement between ODJFS & ODMH A-123-07-0279- Amendment 1
• FY12 Interagency Agreement between ODJFS & ODMH A-123-07-0279- Amendment 2
• FY12 Interagency Agreement between ODJFS & ODMH A-123-07-0279- Amendment 3
• FY10-FY11 Interagency Agreement between ODJFS & ODMH A-1011-07-0635
• FY10-FY11 Interagency Agreement between ODJFS & ODMH A-1011-07-0635 - Amendment 1
• FY10-FY11 Interagency Agreement between ODJFS & ODMH A-1011-07-0635 - Amendment 2
• FY10-FY11 Interagency Agreement between ODJFS & ODMH A-1011-07-0635 - Amendment 3
• FY10-FY11 Interagency Agreement between ODJFS & ODMH A-1011-07-0635 - Amendment 4
• FY10-FY11 Interagency Agreement between ODJFS & ODMH A-1011-07-0635 - Amendment 5
• FY 09 Interagency Agreement between ODJFS & ODMH A-89-07-1319 - Exhibit A 
• FY 08 Interagency Agreement between ODJFS & ODMH A-89-07-0399 - Exhibit A
• FY 06 Interagency Agreement between ODJFS & ODMH A-67-07-0524 - Exhibit A
• FY 06 Interagency Agreement between ODJFS & ODMH A-67-07-0524 - Amendment No. 1 - Exhibit A
• FY 06 Interagency Agreement between ODJFS & ODMH A-67-07-0524 - Amendment No. 2 - Exhibit A
• FY 04-05 Community Medicaid Rate Ceilings - Exhibit D
• Ohio Health Plans Provider Enrollment Application/Agreement for Organizations - Exhibit E (Rev. 1/2012)
• Form W-9 - Exhibit E (Revised October 2007)
• Declaration Regarding Material Assistance/Non-assistance to a Terrorist Organization (DMA) - Exhibit E (July 2006)
• List of Community Medicaid Contract Agencies - Exhibit I (updated 1/07/09)

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Rules and Guidelines

• ODJFS Community Mental Health Agency Services Rules and Guidelines 5101:3-27
• ODADAS-ODMH Guidelines Pertaining to the Implementation of MACSIS under HIPAA, Effective July 1, 2003 (Last Updated January 27, 2005) 
• Analysis of Federal Medicaid Requirements 
• Audit Guidelines 

MACSIS Listservs

To facilitate communications about issues related to MACSIS, the Ohio Department of Mental Health and the Ohio Department of Alcohol and Drug Addiction Services are sponsoring several e-mail listservs. The Board listserv is "private" and is open to Board staff and MACSIS-related State staff only.

• Subscribe to or Unsubscribe from the Board Listserv
• Subscribe to or Unsubscribe from the Provider Listserv

Medicare Part D

The Medicare Modernization Act (MMA), enacted in 2003, established a new benefit for Medicare prescription drug coverage, Medicare Part D. All Medicare beneficiaries are eligible for drug coverage under a Medicare prescription drug plan. These plans cover both brand names and generic drugs. And, very importantly, there is extra help for those in need.

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