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Ohio Medicaid Revises Schedule on Implementation of Major Program Changes


Rather than launch several new programs and administrative changes on July 1, Ohio Medicaid will start OhioRISE as previously scheduled, but stagger the remaining updates to “to ensure smooth member and provider transitions.” Medicaid provided the following details regarding the timeline.

The phased implementation will occur in three stages:

Stage 1:

On July 1, OhioRISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems. This builds on the work already underway including the selection and launch of a statewide network of community-based care management entities, the design and build of a centralized technology for the Child and Adolescent Needs and Strengths assessment tool, transition grant funding to Care Management Entities (CMEs) and MRSS providers (Mobile Response and Stabilization Services) to launch new OhioRISE services and support provider and workforce development; and the completion of extensive community and provider training sessions for more than 1,650 participants.

Stage 2:

In October 2022, Centralized Provider Credentialing will begin through the Ohio Medicaid Enterprise System (OMES) Provider Network Management (PNM) module, which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.

Stage 3:

During the last three months of 2022, ODM will finish implementing the Next Generation program with all seven Next Generation managed care plans beginning to provide healthcare coverage under the new program. ODM will also complete the OMES implementation including the Fiscal Intermediary (FI), which will simplify and streamline the provider process for submitting claims and prior authorizations.

Resources & Guidance:

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