State Demonstration to Integrate Care for Dual Eligible Individuals & Managed LTSS Program
In December 2012, CMS and Ohio signed an MOU for Ohio’s capitated managed care duals demonstration model. Ohio and CMS will contract with Integrated Care Delivery System (ICDS) plans that will oversee the delivery of covered Medicare and Medicaid services for approximately 115,000 Medicare-Medicaid enrollees in seven regions of the state. (Source: CMS website) The plans will serve most dual eligibles age 18 and older in 29 targeted counties; the plan will serve persons with I/DD who are otherwise served in §1915(c) HCBS waiver programs or in ICF/MR facilities. Voluntary enrollment began in September 2013. (Source: CMS and Truven Health Analytics, July 2012; CMS Press Release, link no longer available12/12/2012; State Medicaid website)
Demonstration Proposal (4/2/2012)
Memorandum of Understanding (12/11/2102)
On February 11, 2014, CMS, the state, and the MyCare Ohio Plan entered into a three-way contract. On May 1, 2014, MyCare Ohio began enrolling dual eligibles in MMPs on a voluntary basis only. Passive enrollment for duals will begin on January 1, 2015. (Source: State Medicaid website; MyCare Ohio Enrollment Update; MLTSS Weekly Roundup, link no longer available 3/6/2014; Ohio Medicaid Press Release; HMA Weekly Roundup, 6/18/2014) Three-Way Contract (2/11/2014)
On May 27, 2014, the Columbus Dispatch reported that Medicaid-enrolled Ohio veterans with at least a 70 percent service-connected disability may be eligible to receive free services through the Veterans Administration. The Ohio Department of Veterans Services favors the approach of letting veterans choose whether they want to rely on Medicaid or federal health benefits for long-term care and other types of health care. Senate Bill 101, introduced in 2013, would require the state to notify Medicaid-enrolled veterans that they might be eligible for federal military-related health-care benefits. State officials cannot yet say how many Ohio veterans are enrolled in Medicaid and how much money could potentially be saved by shifting care to VA medical centers. (Source: HMA Weekly Roundup, 5/28/2014; Columbus Dispatch, 5/27/2014)
On August 22, 2014, the state released a MyCare Ohio Update. According to the update, as of August 21, 2014, MyCare Ohio plans have enrolled 100,218 Ohioans, processed 488,305 claims, and paid provider bills totaling $207,974,002. The health plans are working directly with provider associations and others to make it as easy as possible for providers to convert from government-run FFS to private health plans. The update also included an implementation update. (Source: Ohio Medicaid website)
MyCare Ohio Update, link no longer available (8/21/2014)
On September 25, 2014, the state released a MyCare Ohio Update. According to the update, as of September 25, 2014, MyCare Ohio plans have enrolled 100,934 Ohioans, processed 977,030 claims, and paid provider bills totaling $326,976,149. The health plans are working directly with provider associations and others to make it as easy as possible for providers to convert from government-run FFS to private health plans. The update also included an Implementation Update. (Source: Ohio Medicaid website)
MyCare Ohio Update, link no longer available (9/25/2014)
On October 12, 2014, the Columbus Dispatch reported that MyCare Ohio enrollees are experiencing limitations in access to care, due to delays with health home worker payments and service authorization delays. Sam Rossi, the state’s Medicaid spokesperson, said MyCare Ohio health plans have started programs to help independent caregivers and home-health agencies quickly resolve payment problems. (Source: Columbus Dispatch, 10/12/2014)
On June 18, 2015, Ohio passed its biennial budget, which includes significant impacts for MCOs. The budget proposes: requiring MCOs to establish value-based payment arrangements, with 50 percent of payments value-based by July 1, 2020; forbidding managed care plans from implementing prior authorization requirements for individuals receiving alcohol, mental health, or drug addiction services other than those with a requirement under current law; and mandating Ohio Medicaid to improve upon the integrity of its managed care system by July 1, 2016. (Source: Gongwer News Service; The Daily Record, link no longer available 6/19/2015)
Ohio’s State Medicaid Director recently discussed updates to the state’s duals demonstration, MyCare Ohio, with the Joint Medicaid Oversight Committee. The changes include the following: new requirements for MCOs to report to the Ohio Department of Medicaid (ODM) any major changes in provider availability that would affect 100-plus enrollees; new transportation standards, including pick-up times and keeping the member appraised of any changes; clearer payment requirements; reinforcement of the Coordination of Benefits Agreement (COBA), and; guidelines for participating plans for assigning appropriate caseload ratios. (Testimony 8/20/2015)
On January 30, 2017, Governor Kasich of Ohio submitted his proposed budget for fiscal years (FY) 2018-2019. The proposed budget includes appropriations of $28.1 billion for the state’s Medicaid program in FY2018, and $28.8 billion in FY2019.
The budget includes proposals to improve care coordination for all of the remaining Medicaid populations that are not currently enrolled in managed care plans. Additional populations that will be required to enroll into managed care under the proposed budget are:
- Medicaid beneficiaries receiving both home and community-based services as well as those receiving care in a facility;
- Beneficiaries in the state’s Medicaid Buy-In Program for workers with disabilities;
- Dual eligibles that currently are not participating in the state’s dual eligible financial demonstration, My Care Ohio; and
- Eligible beneficiaries in the refugee medical assistance program.
Individuals served through the Department of Developmental Disabilities (DODD) will continue to be carved out of managed care and their services will remain under fee-for-service (FFS), although they will have the option to enroll in an acute care health plan.
Moving forward, Ohio will hold a procurement with the intent to select at least three MCOs to implement a new managed long-term services and supports (MLTSS) program. (Source: Budget Proposal 1/30/2017; Budget Overview 1/30/2017; Care Coordination Overview, link no longer available 1/30/2017)
On April 28, 2017 Cleveland.com reported that Ohio House Republicans included an amendment that would prevent the state from moving to MLTSS until at least 2021. This amendment had been pushed for by the state’s nursing home lobby. The matter will now be taken up by the Ohio Senate. On April 25, 2017, the Ohio Department of Medicaid released a three-year progress report on MyCare Ohio, the states’ initiative to integrate care for dual eligible individuals. The report has a number of interesting highlights that add to Ohio’s debate over moving to MLTSS, including:
- In terms of enrollment, MyCare Ohio has been one of the more successful in the country, with close to 107,000 enrollees.
- Close to 70 percent of enrollees chose to opt-in to the program, the highest rate in the nation.
- Over the 2014-2015 period, the program decreased the number of nursing facility days for residents by 4 percent.
- Ohio Medicaid estimates that the program accrues $2.4 million in monthly savings to the state compared to traditional fee-for-service (FFS) Medicaid. This was achieved while also reducing MyCare Ohio’s capitation rates, which decreased 6.8 percent from 2015 to 2016.
The state also has a new landing page specifically for MLTSS. (Source: Cleveland.com 4/28/2017; MyCare Ohio Progress Report 4/25/2017; Ohio Medicaid MLTSS Page 5/10/2017)
The Ohio State Senate continues to debate the governor’s proposal to implement a comprehensive MLTSS program, according to Statehouse News Bureau. The Ohio Association of Health Plans (OAHP) is advocating for the move, while the states’ nursing home association—the Ohio Health Care Association—opposes it.
The OAHP recently released a new report on MLTSS, The Impact of Managed Care on the Delivery of Medicaid Long Term Services and Supports, which sketches some of the successes of the states that have implemented MLTSS programs and how this applies to Ohio.
The report notes some of the potential benefits of MLTSS programs versus FFS Medicaid including:
- Comprehensive service coordination;
- Increased focus on home and community based services;
- Having a single entity that is held accountable for quality and health outcomes.
(Source: Statehouse News Bureau 5/24/2017; OAHP Report 5/2017)
On June 14, 2017, the Ohio Office of Health Transformation sent an update to stakeholders that included letters of support for the state’s proposed move to an MLTSS system. The letters of support were from the following:
- The Ohio Association of Area Agencies on Aging (o4a);
- The Academy of Senior Health Sciences Inc. (which represents Ohio skilled nursing and assisted living facilities);
- LeadingAge Ohio; and
- The Ohio Association of Health Plans.
The o4a noted in their comments that they appreciated the dialogue with the state on the proposed move to MLTSS, and specifically addressed the legislature's proposal to establish an Advisory Committee to work with the statr on design and effectuation of the MLTSS program; commitment by the state to require that Area Agencies on Aging (AAAs) be waiver service coordinators for MLTSS plans; and further discussion regarding additional inclusion of AAAs in the new MLTSS framework. (Source: Office of Health Transformation, link no longer available 6/14/2017)
On Wednesday, June 28, 2017, both houses of the Ohio legislature passed a revised version of H.B. 49, the legislative vehicle by which the legislature passed a budget for state fiscal years 2018 and 2019. The budget funds the government at $132.8 billion over two years. On June 30 Governor Kasich signed the budget into law, while using his line-item authority to veto 47 items. Two notable items in the budget that Governor Kasich vetoed were:
- Freezing enrollment in the state's Medicaid expansion, and
- Prohibiting the state's department of Medicaid from implementing an MLTSS program without specific authorizing authority from the legislature.
On July 6, the legislature voted to override 11 of the governor’s vetoes, including the prohibition on establishing MLTSS without legislative authorization. The legislature did not vote on Medicaid expansion at this time. . Section 333.283 requires that the Ohio General Assembly must vote to approve inclusion of additional Medicaid LTSS services in managed care beyond the existing Integrated Care Delivery System, which is the state’s dual eligible demonstration, MyCare Ohio.
Section 333.270 of the bill would also mandate the creation of a study committee on Medicaid managed care, made up of legislators, state officials, and numerous provider, trade, and consumer groups. The committee is directed to produce a report no later than December 31, 2018 outlining recommendations regarding Medicaid LTSS. . Once the report is submitted, the committee will be disbanded. (Source: HB 49 7/6/2017; OH Veto Message 6/30/2017; Cleaveland.com)
On August 22, 2017, the Akron Beacon Journal/Ohio.com reported that the Ohio Senate voted to override six of the governor’s vetoes. Notably, the Senate did not vote to override a veto of a provision that would have limited the administration’s ability to implement an MLTSS program. However, on August 21, 2017, the Ohio Department of Medicaid sent a letter to legislative leadership that the state would not move forward with implementing an MLTSS program until the recently-created study committee on MLTSS issues its report, which is due by December 31, 2018. (Source: Ohio.com 8/22/2017; HMA Weekly Roundup 8/23/2017)
Due to a temporary suspension of the Ohio-specific measures in the evaluation of their financial alignment demonstration, only CMS Core quality measures were used in evaluating Ohio’s Demonstration Year 2 (2016) for MyCare Ohio plans. All Financial Alignment Demonstrations include a provision to ‘withhold’ a portion of the Medicare-Medicaid Plans’ capitation rate that can be recaptured if the MMPs meet quality measures. The five MyCare plans had an average performance measure of 83%, with two plans meeting 100%. In 2016, the average percent of quality withholds recaptured increased to 90%, compared to 75% in 2015. Three plans received 100% of withheld funds in 2016. The suspension of the Ohio-specific measures is expected to be temporary as new specifications for the measures are developed (Source: Ohio Medicare Medicaid Plan Demo Year 2 and Ohio Demo Year 1, 6-19-2018)
Balancing Incentive Program
In June 2013, CMS awarded Ohio an estimated $169 million in enhanced Medicaid funds (a 2% enhanced FMAP rate). (Source: CMS BIP website)
BIP Application, link no longer available (3/28/2013)
Structural Change Work Plan, link no longer available (1/31/2014)
On September 10, 2014, the Ohio Department of Medicaid announced it surpassed the 50% spending target for HCBS one full year ahead of the federal deadline of September 30, 2015. (Source: State Governor’s Office of Health Transformation, link no longer available)
HCBS Achievement Announcement, link no longer available (9/10/2014)
A new report published by the Ohio Department of Medicaid notes significant improvement in the states’ Balancing Incentive Program (BIP). Ohio has reached the 50 percent spending target for home and community-based services (HCBS) as a proportion of overall long-term care funding. In June, 2013, Ohio was awarded roughly $169 million in increased federal medical assistance percentage (FMAP) by participating in BIP. (Source: Medicaid.Ohio.gov, 8/1/2015)
In September 2012, CMS approved Ohio’s first Health Home State Plan Amendment for Health Homes targeting Medicaid beneficiaries with SPMI. (Source: CMS Approval Letter, link no longer available; State Health Homes website)
Approved Health Homes State Plan Amendment (9/17/2012)
As of June 2014, Ohio has officially submitted to CMS a second proposed Health Home SPA, but CMS has not yet approved the second Health Home SPA. (Source: CMS Health Home Proposal Status website, 6/2014; Kaiser Health Home State Plan Option website, 6/2014)