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Client Alert

ODM to Implement Medicaid Work Requirements: What Providers and Medicaid Expansion Recipients Need to Know

March 21, 2025The Ohio Department of Medicaid (ODM) has submitted a waiver to impose work requirements for Medicaid expansion recipients. If approved, the new eligibility criteria will take effect on January 1, 2026. A federal public comment period is open until April 7, 2025.Client Alert

Ohio Appellate Court Rules in Favor of Gender-Affirming Care

March 19, 2025On March 18, 2025, the 10th District Court of Appeals in Franklin County ruled that Ohio’s House Bill (HB) 68, which restricts puberty blockers and hormone therapy for minors seeking gender-affirming care, violates the Health Care Freedom Amendment and is therefore unenforceable. The court found that the law unlawfully interferes with parental rights and medical decision-making. The case, Moe v. Yost, has been remanded, and Ohio Attorney General Dave Yost intends to appeal.Client Alert

HHS Revokes Public Comment Requirement on Certain Policy Changes

March 5, 2025The U.S. Department of Health and Human Services (HHS) has revoked the Richardson Waiver, eliminating the requirement for public notice and comment on certain policy changes. This decision allows HHS to implement new policies more quickly, potentially affecting healthcare funding rules like Medicaid work requirements. While it speeds up policymaking, it also reduces opportunities for stakeholder input, raising concerns over transparency and unintended consequences for healthcare providers, states, and patients.Client Alert

Ohio Recovery Housing Operators Beware: House Bill 58 Seeks to Make Major Changes

February 26, 2025Ohio House Bill 58 proposes significant changes to recovery housing oversight, granting ADAMH Boards authority to inspect and investigate recovery residences. The bill also introduces a Certificate of Need (CON) program, requiring state approval for major facility changes. OMHAS will assess applications based on cost, quality, accessibility, and financial feasibility. The bill also establishes a recovery housing residence fund to support inspections. For more information, contact BMD attorneys Daphne Kackloudis or Jordan Burdick.Client Alert

January 2025 Notice of Proposed Rulemaking Brings Notable Changes to HIPAA Security Rule

February 25, 2025In January 2025, the U.S. Department of Health and Human Services proposed amendments to the HIPAA Security Rule, aiming to enhance cybersecurity for covered entities (CEs) and business associates (BAs). Key changes include mandatory compliance audits, workforce training, vulnerability scans, and risk assessments. Comments on the proposed rule are due by March 7, 2025.Client Alert

New Ohio Recovery Housing Rules Take Effect January 1, 2025

January 2, 2025Ohio’s new recovery housing rules, effective January 1, 2025, require certified community behavioral health providers to refer clients only to accredited recovery housing residences listed on the statewide registry.Client Alert

SCOTUS to Weigh In on Medicaid Beneficiaries’ Right to Choose their Provider

January 2, 2025The U.S. Supreme Court will hear arguments this spring on whether Medicaid beneficiaries have an enforceable right to choose their healthcare providers without state interference, as outlined in Section 1902(a)(23) of the Social Security Act. This case stems from a South Carolina petition challenging a Fourth Circuit ruling that blocked the state from terminating Planned Parenthood’s Medicaid provider agreement.Client Alert

Parental Approval Mandate for Diagnosing Gender-Related Conditions in Minors under Ohio House Bill 68

September 4, 2024Ohio House Bill 68, effective August 6, 2024, introduces strict guidelines for mental health professionals diagnosing and treating minors with gender-related conditions. The law mandates parental or guardian consent before any diagnosis or treatment can proceed. Additionally, professionals must first screen for other comorbidities and assess for any history of abuse. Failure to adhere to these requirements can result in disciplinary action for unprofessional conduct.Client Alert

New Medicare Billing Rules: What MFTs, MHCs, and IOP Providers Need to Know

July 9, 2024Starting January 1, 2024, Medicare began covering services provided to Medicare beneficiaries by marriage and family therapists, mental health counselors, and Intensive Outpatient Program (IOP) services. With this change, Medicare has become the primary payer for these services.Client Alert

Chevron Doctrine No More: What the Supreme Court’s Ruling Means for Agency Authority

July 2, 2024On June 28, 2024, the Supreme Court invalidated the Chevron doctrine, nearly 40 years after it first took effect.Client Alert

Ohio Board of Pharmacy Update: Key Regulatory Changes and Proposals You Need to Know

June 26, 2024The Ohio Board of Pharmacy (BOP) has rescinded certain OAC rules (OAC 4729:5-18-01 through 4729:5-18-06), removing regulations on office-based opioid treatment (OBOT) clinics. The rescissions took effect on June 3, 2024. The BOP also published a new rule, OAC 4729:8-5-01, which sets explicit reporting guidelines for licensed dispensaries and became effective on June 7, 2024.Client Alert

Ensuring Fair Access: SB 269 Protects Affordable Medication for Low-Income Patients

May 29, 2024SB 269, introduced on December 19, 2023, will ensure that 340B covered entities, including Federally Qualified Health Centers, Ryan White Clinics, disproportionate share hospitals, and Title X clinics, can acquire 340B drugs without facing undue restrictions or discriminatory practices from drug manufacturers and distributors. This protection is crucial for 340B covered entities to continue to provide affordable medications and comprehensive services to low-income patients.Client Alert

Unveiling Ohio's Pharmacy Board Updates for Distributors, Mobile Clinics, and Controlled Substances

May 24, 2024The Ohio Board of Pharmacy will hold a public hearing on May 28, 2024, to discuss several proposed changes and additions to Ohio Administrative Code (OAC). These changes pertain to terminal distributors of dangerous drugs (TDDDs), mobile clinics or medication units, and the classification of controlled substances.Client Alert

House Bill 249: Key Updates to Involuntary Hospitalization Law for Mental Health Providers

May 23, 2024House Bill 249 (HB 249) proposes changes to Ohio Revised Code (ORC) Sections 5122.01 and 5122.10 to expand the conditions under which a person with a mental illness can be involuntarily hospitalized.Client Alert

Chemical Dependency Professionals Board Rule Changes: Part 2

April 1, 2024New rule changes for Certification of Chemical Dependency Counselor Assistants (CDCA)Client Alert

Board of Pharmacy Rule Changes

April 1, 2024Board of Pharmacy made changes to rules effective on March 4, 2024Client Alert

Counselor, Social Workers, and Marriage and Family Therapist (CSWMFT) Board Rule Changes

March 29, 2024The Counselor, Social Workers, and Marriage and Family Therapist (CSWMFT) Board has proposed changes to the Ohio Administrative Code rules discussed below. The rules are scheduled for a public hearing on April 23, 2024, and public comments are due by this date. Please reach out to BMD Member Daphne Kackloudis for help preparing comments on these rules or for additional information.Client Alert

Latest Batch of Ohio Chemical Dependency Professionals Board Rules: What Providers Should Know

March 25, 2024The Ohio Chemical Dependency Professionals Board recently released several new rules and proposed amendments to existing rules over the past few months. A hearing for the new rules was held on February 16, 2024, but the Board has not yet finalized them.Client Alert

The Ohio State University Launches Its Accelerated Bachelor of Science in Nursing Program

February 27, 2024In response to Ohio’s nursing shortage, The Ohio State University College of Nursing is accepting applications for its new Accelerated Bachelor of Science in Nursing program (aBSN). Created for students with a bachelor’s degree in non-nursing fields, the aBSN allows such students to obtain their nursing degree within 18 months. All aBSN students will participate in high-quality coursework and gain valuable clinical experience. Upon completion of the program, graduates will be eligible to take the State Board, National Council of Licensure Exam for Registered Nursing (NCLEX-RN).Client Alert

Enhancing Privacy Protections for Substance Use Disorder Patient Records

February 16, 2024On February 8, 2024, the U.S. Department of Health and Human Services (“HHS”) finalized updated rules to 42 CFR Part 2 (“Part 2”) for the protection of Substance Use Disorder (“SUD”) patient records. The updated rules reflect the requirement that the Part 2 rules be more closely aligned with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) privacy, breach notification, and enforcement rules as mandated by the Coronavirus Aid, Relief, and Economic Security Act of 2020.Client Alert

The Ohio Chemical Dependency Professionals Board’s Latest Batch of Rules: What Providers Should Know

January 26, 2024The Ohio Chemical Dependency Professionals Board has introduced new rules and amendments, covering various aspects such as CDCA certificate requirements, expanded services for LCDCs and CDCAs, remote supervision, and reciprocity application requirements. Notable changes include revised criteria for obtaining a CDCA certification, expanded services for LCDCs and CDCAs, and updated ethical obligations for licensees and certificate holders, including non-discrimination, confidentiality, and anti-sexual harassment measures.Client Alert

Governor Mike DeWine and The Ohio State University Introduce the SOAR Study on Ohio Mental Illness

January 22, 2024On January 19, Ohio Gov. Mike DeWine and The Ohio State University announced a new research initiative, the State of Ohio Adversity and Resilience (“SOAR”) study, which will investigate all factors influencing Ohio’s mental illness and addiction epidemic.Client Alert

The Ohio Board of Pharmacy’s Latest Batch of Rules: What Providers Should Know

January 15, 2024The Ohio Board of Pharmacy released several new rules and proposed amendments to existing rules over the past month that will significantly impact pharmacy operations. Topics range from updates to the Terminal Distributor of Dangerous Drugs license to mobile clinics to mandatory rest breaks for pharmacists of outpatient pharmacies. A summary of the proposed changes is below, along with instructions for commenting on the rules. Your BMD healthcare attorney can help write comment letters and submit the comments on your behalf as well.Client Alert

Increased Medicaid Rates to Take Effect This Month for Ohio Providers

January 5, 2024As required by House Bill 33, Ohio’s 2024-2025 operating budget bill, reimbursement rates paid by the Ohio Department of Medicaid will increase for a wide range of providers starting on January 1, 2024.Client Alert

The Second Wave of UnitedHealthcare's Prior Authorization Cuts Started in November

December 11, 2023In August 2023, UnitedHealthcare released its plan to eliminate roughly one-fifth of its then-current prior authorization requirements. The first round of prior authorization cuts took effect on September 1, 2023. In that round, UnitedHealthcare eliminated the necessity for some prior authorizations for UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plan members. The second and final round of prior authorization cuts began on November 1, 2023. The November 2023 Prior Authorization Cuts apply to the same plans as well as community plans (i.e., Medicaid managed care plans).Client Alert

Legal Uncertainties Remain Following Passage of Issue 1 in Ohio

December 11, 2023In the November 2023 General Election, Ohio voters passed Issue 1 which, among other things, “[e]stablish[es] in the Constitution of the State of Ohio an individual right to one’s own reproductive medical treatment, including but not limited to abortion”. Despite passage of Issue 1, questions persist about how its codification on December 7 affects previously passed legislation restricting abortion and related pending court cases.Client Alert, Multimedia

WEBINAR SERIES RECAP | Ending the Public Health Emergency + Post-Pandemic Check-Up

May 10, 2023Some may take the position that the rest of the country already returned to a new “normal” following the COVID-19 pandemic.  But healthcare providers continue to implement COVID protocols and navigate the ever-changing healthcare regulations at both the federal and state levels.  It is important for healthcare providers to take time for a “Healthcare Check-Up” with the start of 2023 and the ending of the Public Health Emergency (“PHE”).Client Alert

No Surprises Act Update: The IDR Portal is Open

April 25, 2022The No Surprises Act (“NSA”) became effective January 1, 2022, and has been the subject of lawsuits and criticisms since its inception. The goals of the No Surprises Act are to shield patients from surprise medical bills, provide to uninsured and self-pay patients good faith estimates of charges, and create a process to resolve payment disputes over surprise bills, which arise most typically in emergency care settings. We have written about Part I and Part II of the NSA previously. This update concerns the Independent Dispute Resolution (“IDR”) procedure created by Part II but applicable to claims covered by Part I. The Centers for Medicare & Medicaid Services (“CMS”) finally opened the Portal for providers to submit disputes to the IDR process following some updated guidance regarding the arbitration process itself.Client Alert

Updated FAQs for the No Surprises Act - Good Faith Estimates

April 7, 2022The No Surprises Act (“NSA”) became effective January 1, 2022. Meant to protect consumers from surprise medical bills, the new law is good for consumers, but vexatious for health care providers and facilities. One particular source of frustration is the operationalization of the Good Faith Estimate (“GFE”) requirement, governed by Part II of the regulations that implement the NSA. The GFE requirements apply broadly to all healthcare providers and facilities that practice within the scope of their state-issued license.Client Alert

Interesting Trends Revealed in 50-State Medicaid Budget Survey

November 3, 2021Results of the KFF annual survey of state Medicaid directors reveal some fascinating trends in Medicaid service delivery and benefit coverage. Read on for a summary of the highlights we find most noteworthy. Background As a preliminary matter, many of the trends KFF identifies and that we highlight below are no doubt a result of the Covid-19 pandemic. The pandemic triggered a public health emergency and economic crisis that resulted in increased Medicaid enrollment, service offerings, and flexibility in service delivery, along with a heightened awareness of disparities in access to care and health outcomes.Client Alert

S.B. 263 Protects 340B Covered Entities from Predatory Practices in Ohio

January 14, 2021Just before the end of calendar year 2020 and at the end of its two-year legislative session, the Ohio General Assembly passed Senate Bill 263, which prohibits insurance companies and pharmacy benefit managers (“PBMs”) from imposing on 340B Covered Entities discriminatory pricing and other contract terms. This is a win for safety net providers and the people they serve, as 340B savings are crucial to their ability to provide high quality, affordable programs and services to patients.Client Alert

BMD COVID-19 Healthcare Provider Resource Guide

March 18, 2020Providers - for the latest information related to Medicaid/Medicare, Telehealth, HIPAA, CPT Codes, as well as Ohio and Federal Information, click here for a comprehensive resource guide to navigating during the Coronavirus pandemic.