In 2019, the Ohio Department of Medicaid (ODM) launched a series of procurements and strategic initiatives with the goal of creating a next generation managed care program focused on the individual. This focus supports us in doing better for the people we serve and the providers who are our partners.

Contracting with ODM’s Next Generation MCOs

Providers interested in contracting with Ohio Medicaid’s next generation MCOs can contact them via the Provider Relations contact information listed in the table below.

Contracting with the OhioRISE Plan

Providers interested in contracting with Aetna to provide behavioral health services to children and youth enrolled in the OhioRISE program are encouraged to contact Aetna Better Health of Ohio. Providers can contact Aetna via the Provider Relations contact information listed below.

Attention Providers Who Wish to Assess Children/Youth for the OhioRISE Program!

As of May 2, the Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) Information Technology (IT) System is available for all certified Ohio Children’s Initiative CANS assessors to begin conducting CANS assessments with a child/youth. The new OhioRISE program will use the Ohio Children’s Initiative CANS tool to establish eligibility and to inform care planning and decision-making for children and adolescents with behavioral health needs. Certified Ohio Children’s Initiative CANS assessors are expected to use the CANS IT System to gather all information about the child/youth and family story to describe their strengths and needs. 

There are actions that you must take in order to use the CANS IT System to conduct CANS assessments with a child/youth and to bill Medicaid for CANS assessments beginning July 1, 2022. 

• Click here to view the CANS Resources page of the OhioRISE webpage, where you will find guidance for obtaining Ohio Children’s Initiative CANS certification, billing for CANS assessments, and accessing the CANS IT System. 
• If you plan to bill Medicaid, the OhioRISE plan, or Medicaid managed care organizations for CANS assessments, you must be an enrolled Medicaid provider and add the “ORC – CANS Assessor” specialty to your enrollment. Click here to view the OhioRISE Provider Specialties Guide for guidance. 

New OhioRISE Provider Specialties Are Available 

As of March 9, several new provider specialties associated with the implementation of the OhioRISE program are available to you. ODM requires that providers add a provider specialty to their provider enrollment type in order to bill for some new and enhanced services under this program and as part of the Next Generation of Ohio Medicaid. For additional information about the new specialties and their requirements, click here to view the OhioRISE Provider Specialties Guide.

Enrolled Providers: If you are currently enrolled as an ODM provider, plan to offer any of the new and enhanced services, and have the appropriate certification/documentation, please email ODM at Medicaid_Provider_Update@medicaid.ohio.gov as soon as possible. Request that the applicable specialty for the new service be added to your existing provider type, include your NPI and Ohio Medicaid ID, and attach required documentation.

New Providers: If you are a provider who is not currently enrolled in the Ohio Medicaid program and wish to enroll to provide any services under the Next Generation of Medicaid, please visit the following link to the Ohio Medicaid online application: https://portal.ohmits.com/Public/Providers/Enrollment/tabId/49/Default.aspx. If your enrollment requests the addition of more than one specialty, after your enrollment is complete, please email ODM at Medicaid_Provider_Update@medicaid.ohio.gov to submit the required documentation for the new specialties.

Enrolling as a Medicaid provider and/or adding the appropriate OhioRISE provider specialty to your enrollment will allow you to bill ODM for the new services you provide to OhioRISE-enrolled children starting July 1. You must have the appropriate OhioRISE provider specialty added to your enrollment in order to bill Medicaid for the new OhioRISE services listed above on and after July 1, 2022. To avoid delays in claims payment after July 1, it is critical for providers to add these specialties as soon as possible.

Medicaid Managed Care Procurement Award

On April 9, 2021, ODM announced the selection of six managed care plans to lead the department’s evolution of managed care services for its more than 3 million members and thousands of medical providers. Additional information about the announcement can be found in the press release and supplemental briefing document. 

The selection reflects the results of intensive stakeholder engagement efforts to define opportunities to strengthen the structure of Ohio’s $20 billion managed care program. It addresses Governor Mike DeWine’s direction at the beginning of his term to re-evaluate Ohio’s managed care system with the goal of making the system more focused on individuals.  

The seven MCOs selected for the next generation managed care program are: 

• AmeriHealth Caritas Ohio, Inc.
• Anthem Blue Cross and Blue Shield
• Buckeye Community Health Plan
• CareSource Ohio, Inc.
• Humana Health Plan of Ohio, Inc.
• Molina Healthcare of Ohio, Inc.
• UnitedHealthcare Community Plan of Ohio, Inc.

Previous Procurement Phases: Request for Applications (RFA) and Requests for Information (RFIs)

We begin by first considering feedback and suggestions from individuals and providers when making decisions about how to evolve the Medicaid managed care program in Ohio. The feedback received through our first Request for Information (RFI #1) informed development of RFI #2, outlining our vision for the next generation of Ohio's Medicaid managed care program. The second RFI sought input from providers, associations, advocacy groups, data and information technology vendors, and managed care organizations. The response period for both RFI #1 and RFI #2 closed on Tuesday, March 3, 2020.

This feedback informed the program design reflected in Ohio Medicaid’s next generation program structure and procurement processes.

Communicating with ODM

The Medicaid mailbox will remain open as a way for providers to communicate with ODM about the current Medicaid managed care program. For feedback or observations related to the Managed Care Procurement, you can also contact us through the Next Generation mailbox or by visiting the Contact Us page.