On September 30, 2020, ODM released a Request for Applications (RFA) for the Managed Care Procurement for those interested in becoming managed care plans for children and adults within the Ohio Medicaid program. The selected plans will be an essential piece in improving the health and lives of millions of Ohioans. Watch the below video for more details about the Managed Care RFA.
The presentation from the Pre-Application Conference is also available.
The Managed Care Procurement RFA closed on November 20, 2020. As a next step in this process, Ohio Medicaid will evaluate the responses to the RFA, and the applicants will be required to conduct oral presentations. Once oral presentations have concluded, new managed care organizations will be selected in late January 2021. Services under the new contracts are not scheduled to begin until January 2022; any changes to Ohio’s Medicaid MCOs will NOT disrupt member coverage or access to care.
To learn more about the next steps of the Managed Care RFA and the quiet period, watch the video below.
Additional details and a link to the RFA can be found on the RFPs page of medicaid.ohio.gov.
In future phases, after ODM has completed scoring and awarding new managed care contracts, we will conduct a thorough transition to support individuals, providers, and managed care organizations including providing details about expected changes and assistance in navigating those changes.
Procurement "Quiet Period"
Like any procurement of this size, there are significant guardrails placed in both federal and state law regarding communications during certain periods of contract procurements. ODM must adhere to federal and state procurement requirements to ensure a fair process. As a result, ODM cannot:
- Share details related to RFA responses received and/or award prior to official public announcements.
- Communicate design discussions and decisions related to the managed care structure beyond what is stated in the RFA.
At this point in time, ODM is in the “quiet period” for the Managed Care Procurement, which dramatically limits the information available to share on an individual basis. All information ODM releases regarding the Managed Care Procurement must be at equal opportunity.
Features of Ohio’s Next Generation Managed Care Program
ODM has designed its future Medicaid managed care program to achieve the following goals:
- Improve wellness and health outcomes
- Emphasize a personalized care experience
- Support providers in better patient care
- Improve care for children and adults with complex needs
- Increase program transparency and accountability.
Ohio’s Medicaid managed care program will advance many of these goals through ODM’s population health approach, which is designed to address health inequities and disparities and achieve optimal outcomes for the holistic well-being of individuals receiving Medicaid.
ODM envisions a Medicaid managed care program where ODM, the MCOs, and OhioRISE (Resilience through Integrated Systems and Excellence) - a single, statewide prepaid inpatient health plan - are responsible for providing behavioral health services to children involved in multiple state systems and/or with complex behavioral health needs. In the future program, a single pharmacy benefit manager (SPBM) will be responsible for providing and managing pharmacy benefits for all individuals along with coordinating and collaborating to achieve health care excellence through a seamless service delivery system for individuals, providers, and systems partners.
To reduce provider burden and promote consistency across the Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions and prior authorization submissions and for credentialing and re-credentialing. ODM’s fiscal intermediary (FI) will serve as a single clearinghouse for all medical (non-pharmacy) claims. ODM’s FI will also serve as the single, centralized location for provider submission of prior authorization requests. Under ODM’s centralized credentialing process providers will submit an application for Medicaid enrollment and credentialing to ODM and will not need to submit credentialing and re-credentialing materials to MCOs.