OHIO MEDICAID MANAGED HEALTH CARE PROGRAM STATEWIDE UPDATE
Program Highlights for Counties and Interested Parties
QUARTERLY REPORT January 2004
Issued by the Office of Ohio Health Plans, Bureau of Managed Health Care
This report is issued quarterly by the Bureau of Managed Health Care to share updated program information with managed care plans, communities, providers, and other interested stakeholders of Medicaid managed care in Ohio.
ENHANCED CARE MANAGEMENT (ECM) PROGRAM UPDATE On October 21, 2003 the Ohio Department of Job and Family Services (ODJFS) issued a Request for Applications (RFA) for the delivery of "Enhanced Care Management (ECM)" to certain Aged, Blind, or Disabled (ABD) Medicaid consumers in selected counties. Eligible applicants are organizations, or collaboratives of organizations, that have the ability to offer the required comprehensive care management services and that agree to meet program specifications for accountability and quality. Applicants that demonstrate this capacity in response to the RFA and during a subsequent readiness review phase will be eligible to enter a provider agreement with ODJFS as an ECM provider. Organizations interested in submitting an application were required to attend the mandatory applicant information conference on November 19, 2003 and submit a letter of intent by December 10, 2003. The deadline for applications is March 1, 2004, 3 p.m. EST. Information on organizations submitting letters of intent, as well as additional information about the ECM program is available at the following web site: www.jfs.ohio.gov/ohp/bmhc/applibrary.stm Included in the initial ECM eligible population will be adults with a diagnosis of diabetes; congestive heart failure (as well as coronary artery disease and non- mild hypertension); chronic obstructive pulmonary disease or asthma; and children with a diagnosis of asthma. The initial service areas for program implementation are: Cuyahoga County Franklin County Hamilton County Lucas County Montgomery County Stark County Summit County Zanesville Cluster (Muskingum, Coshocton, Guernsey, Morgan, Noble, and Perry Counties)
MCP PREMIUM RATES The state fiscal year (SFY) 2004-2005 budget establishes specific requirements for annual inflationary increases in Medicaid reimbursement to Children's Hospitals for inpatient services. Due to a recent increase in the inflationary rate to be applied compared to the percentage estimated in the calendar year (CY) 2004 managed care rate cells, minor revisions in some rate cells were required. The revised rates will be posted on the Bureau's website at: http://jfs.ohio.gov/ohp /bmhc/
BUCKEYE COMMUNITY HEALTH PLAN CONTRACT Family Health Plan (FHP, headquartered in Toledo) has executed an asset transfer agreement with Buckeye Community Health Plan (BCHP) for the transfer of FHP's
Medicaid members in Lucas County. BCHP is a wholly-owned subsidiary of Centene Corporation, a publicly- traded for-profit company based in St. Louis. Centene Corporation provides managed care programs and related services to over 439,000 Medicaid consumers in four states (Indiana, New Jersey, Texas, and Wisconsin). BCHP successfully met all program requirements to become a Medicaid-contracting managed care plan in Lucas County; therefore, FHP's members were transferred to BCHP effective January 1, 2004. BCHP has many of the same providers that were available to FHP members. FHP members were notified on December 1, 2003, that their membership was to be automatically transferred to BCHP effective January 1, 2004, unless they chose a different managed care plan. FHP members and providers should contact FHP regarding any issue/question for services provided prior to January 1, 2004, and contact BCHP with any issues/questions regarding services provided January 1, 2004, and after.
MCP MEMBERSHIP Current Membership Statewide MCP membership as of January 1, 2004 is 489,362, which reflects an increase of 16,737 members over October 2003 membership. Six MCPs serve Medicaid managed care members in 15 counties. Total membership in the four mandatory counties is 293,465, or 94% of eligibles. Total me mbership in the six Preferred Option counties is 193,811 (60%); MCP members in the five voluntary counties are 2,086.