Ohio’s State Budget & Community Health Centers

Ohio’s State Budget & Community Health Centers: 

A Policy Wonk’s Perspective

House Bill 166, the state biennial operating budget, was enacted into law officially on July 18 with Governor DeWine’s signature and his subsequent vetoes. Overall, health center advocates are pleased with the progress made (and/or maintained) in HB 166, and we thank each and every advocate that contributed along the way!  Your advocacy matters, and truly made a difference. See a bulleted list of our priorities below:
•Medicaid Expansion remains intact!
•FQHC Primary Care Workforce Initiative (OPCWI) was fully restored (and slightly increased)!
•Names FQHCs to the Health Care Workforce Preparation Task Force - The Ohio Physician and Allied Health Care Workforce Preparation Task Force is created to study, evaluate, and make recommendations with respect to health care workforce needs in Ohio. FQHC representation is specifically noted in the Task Force composition
•Pharmacy/PBM Items: 

• Dispensing Fees – Requires ODM to adopt rules to provide to pharmacies a supplemental dispensing fee under the care management system. Provides that the dispensing fee must include at least three different payment levels 
• Single PBM- Requires the Medicaid Director, not later than July 1, 2020, to select a provisional single state pharmacy benefit manager (PBM) to administer pharmacy benefits for Medicaid managed care organizations (MCOs) 
• Requires the Director to collect from the state PBM clinical data
• Requires a PBM under contract with a Medicaid MCO to administer pharmacy services under the care management system to: (1) Upon the request of ODM, disclose all of its received payment streams, including drug rebates, discounts, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other payments
• Prescribed Drugs - Permits, instead of requiring, ODM to include prescribed drugs in the Medicaid managed care system
• Prescribed Drug Spending - Requires the Medicaid Director, not later than July 1, 2020, to establish an annual benchmark for prescribed drug spending growth under the Medicaid Program
• Establishes an appeals process for prescription drugs maximum allowable cost- Requires the Medicaid Director to establish an appeals process that pharmacies can use to bring to the Department of Medicaid disputes about the maximum allowable cost set by the state PBM for a prescription drug
• Prescribed Drug Claims Processing Pilot Program- Requires ODM by Jan 1, 2020, to establish a Southeast Ohio pilot program for pre-audit processing of Medicaid MCOs and pharmacy benefit manager prescribed drug claims 

•Telehealth - Effective Jan.1, 2021, requires all commercial health benefit plans to provide coverage for telemedicine services on the same basis and to the same extent as in-person services. Prohibits such plans from excluding telemedicine services from coverage solely because they are telemedicine services but does not ensure payment parity. Note, expanded telehealth rules on Medicaid effective date of July 4

•Infant Vitality –includes funding under the Department of Health and Medicaid for home visiting and infant vitality interventions and for Produce Perks Midwest. Additional funding for birth spacing was unfortunately removed
•Improves Access to the Breast and Cervical Cancer Project (BCCP): increases eligibility to 300% of the FPL, eliminates the requirement that women be younger than 65, and lowers the age from 25 to 21 at which women with a family history or clinical exam results are eligible for screening and services
•School Wellness and Success Funding – Increases the amounts to $275M in FY20 and $400M in FY21 and expands permissible uses of student wellness and success funds (FQHCs are eligible partners; funding can also be used for capital expenses)
•SDOH – Requires the Medicaid Director to implement strategies that address social determinants of health and employment
•CPC/CPC for Kids – Funding intact 
•Managed Care

• Medicaid Prompt Pay – Requires Medicaid MCOs to submit claims in accordance with requirements established by the Department of Insurance (i.e. mirroring commercial prompt pay law) 
• Medicaid managed care performance - Requires that ODM's website include the metrics ODM uses to determine a Medicaid managed care organization's contract performance. 
• Requires ODM, in addition to the MCO performance payment program to establish performance metrics, which may include financial incentives and penalties, to evaluate and compare Medicaid MCO contract performance and then post the metrics to the website
• Requires ODM to update its website quarterly to reflect any changes to the metrics used

•MyCare Ohio / Standardized Claims Forms -  

• Requires the Director to (1) select a standardized claim form for each provider type from among universally accepted claim forms used in the US and (2) require that a provider that renders a medically necessary health care service under MyCare Ohio use the form
• Requires the Medicaid Director to create standardized claim codes that allow a provider that renders a medically necessary health care service under MyCare Ohio to use the same code for that service, regardless of the payor

From the OACHC Policy Team, THANK YOU again for all you have done and continue to do!