What is HB 169 Ohio?

Table of Content

As of June 23, 2021, three bills are pending in the Ohio state legislature that would effectively ban mandatory COVID-19 vaccines. During all three bills, H.B. 248, S.B. 169 and S.B. 350, would effectively ban COVID-19 immunization requirements by public and private employers, but they differ in scope and implementation. Below is a summary of the three bills.

The text of 248 does not directly prohibit COVID-19 vaccination requirements, but allows people to opt out if they have medical contraindications, natural immunity, or reasons of conscience, including religious beliefs. In addition, the bill would allow people to reject not just the COVID-19 vaccine, but any vaccine, including meningitis, hepatitis and chickenpox.

Good news! CMS has approved the managed care portion of provider support payments for Behavioral Health, MyCare Ohio, and several other types of providers. Unlike previous provider support payments, Medicaid managed care plans process these payments directly to providers. ODM is working with them to distribute these funds as quickly as possible.

Managed Care Prepress Relief Payment is calculated at 10% of claims; However, the amount that providers receive with this first payment is 50% of the total amount.
This was required by CMS to prevent a situation where a vendor could be “overpaid”.
At the end of calendar year (CY) 2022, ODM will reconcile a provider’s total claims with actual claims experience in CY22 and a final indemnification payment will be calculated.
No action is required from the vendor during this reconciliation process.
ODM will be working on this final support installment with plans at the end of the year.
ODM sends an announcement when the last installments are prepared and displays the final payment amount on the dashboard.
We apologize for the complexity of this process and thank you for your understanding.

Only the customer’s 12-digit Medicaid number will be accepted. We encourage all of our customers to change any customer’s MCO number (except Paramount) to their Medicaid ID number. All MCOs except Paramount pay and award today when you submit your Medicaid ID number or an assigned unique ID number.
MyCare plans, both Medicare and Medicaid (combined or separate), are not submitted through the OMES portal. These must be submitted to your clearinghouse along with Medicare, Medicare Advantage, and commercial payers. It is important that all MyCare customers are identified and provided with the correct MyCare payer by July 1st, 2022.
There will be new Payer IDs for all 8 MCOs. These will be included in the more detailed statement we will send out once Qualifacts has determined how they can help from a structural and functional perspective. Ohio Rise also ships via OMES, whether you are a CME or a Vendor.
MITS ends June 22, 2022. FI activates July 1, 2022. MCO applications before and after July 1, 2022 will be submitted via OMES (FI). I will know whether or not Paramount DCM is included in the July Pre-1 pool and if so how they should be submitted.
Each MCO and Ohio Rise must be submitted in separate files via OMES.

Legislative Week Review

Prepared By: Andrew Herf

Email: aherf@shumakeradvisors.com

Managed Care Prepress Relief Payment is calculated at 10% of claims; However, the amount that providers receive with this first payment is 50% of the total amount.

This was required by CMS to prevent a situation where a vendor could be “overpaid”.

At the end of calendar year (CY) 2022, ODM will reconcile a provider’s total claims with actual claims experience in CY22 and a final indemnification payment will be calculated.

No action is required from the vendor during this reconciliation process.

ODM will be working on this final support installment with plans at the end of the year.

ODM sends an announcement when the last installments are prepared and displays the final payment amount on the dashboard.

We apologize for the complexity of this process and thank you for your understanding.

There will be new Payer IDs for all 8 MCOs. These will be included in the more detailed statement we will send out once Qualifacts has determined how they can help from a structural and functional perspective. Ohio Rise also ships via OMES, whether you are a CME or a Vendor.

MITS ends June 22, 2022. FI activates July 1, 2022. MCO applications before and after July 1, 2022 will be submitted via OMES (FI). I will know whether or not Paramount DCM is included in the July Pre-1 pool and if so how they should be submitted.

Each MCO and Ohio Rise must be submitted in separate files via OMES.

Legislative Week Review