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July 2024 Managed Care Plan Updates

This past month, the managed care plans have published updates on events and policy changes impacting their organizations.

Ohio Department of Medicaid: 

The Ohio Department of Medicaid (ODM), in partnership with Ohio’s Medicaid managed care organizations (MCO), is investing into the health of Ohio communities through a new yearly grant program.  The grants, worth more than $6.5 million, were awarded to 17 projects or organizations through the Medicaid Community Reinvestment initiative.

The new initiative is designed to build healthier communities and reduce health inequities throughout the state. ODM’s Next Generation Managed Care Model uses data to inform and encourage cross-agency collaboration and requires managed care organizations (MCOs) to partner together and reinvest a portion of their contract proceeds into community-based programs like expanding mental health services in underserved communities and supporting food prescriptions in rural areas. The new model focuses on population health, or the health of all Ohio communities. Click here to learn more.

 

AmeriHealth Caritas: 

Beginning July 22, 2024, the HCPCS codes and services listed in this table will require prior authorization. As a reminder, when you need to verify whether a service requires prior authorization, use the Prior Authorization Lookup Tool on the AmeriHealth Caritas provider website.

 

CareSource: 

As of July 1, 2024, CareSource has partnered with DentaQuest to cover Dental Services for Ohio Medicaid CareSource members. To learn more, click here.

 

Molina Healthcare:  

Molina posted the following Prior Authorization (PA) Code Change documents under the Provider Website Forms tab for a July 1,2024, effective date. Information includes non-covered codes, new codes that require PA and which codes no longer require PA. Click here to view the Medicaid Prior Authorization Code Changes form from Molina.

 

Buckeye:

Buckeye Health Plan’s annual provider satisfaction survey will launch later this summer and they hope you’ll take a moment to share your feedback. This survey serves as the foundation for key improvement initiatives that they undertake each year and your feedback is critical to making sure they address the issues that are important to you.

Also, view Buckeye’s most up to date payment policy updates here.

 

United Healthcare:

United Healthcare has updated reimbursement policies around “Discarded Drugs and Biologicals” for Ohio Medicaid providers. View the updates here.

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