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Increased Medicaid Rates to Take Effect This Month for Ohio Providers

Client Alert
January 5, 2024

As 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. The rate increases total roughly $3.4 billion per year and apply to the following types of providers:

  • Non-institutional providers:
    • Ambulatory surgical centers / dialysis
    • Testing / lab / X-ray / durable medical equipment
    • Physicians / advanced practice registered nurses / physician assistants / clinics / skilled therapy
    • Vision and eye care
  • Community behavioral health providers
  • State plan private duty nursing / home health providers
  • Home and Community Based Services waiver providers:
    • PASSPORT waiver providers
    • Assisted living waiver providers
    • Ohio home care waiver providers
    • MyCare Ohio waiver providers
    • Individual Options waiver
    • Level 1 waiver providers
    • Self-Empowered Life Funding (SELF) waiver providers
  • Department of Developmental Disabilities providers

Beginning on January 1, 2024, the majority of the codes in the Ohio Medicaid fee schedule for non-institutional providers increased by 5% or more. Specifically, there was approximately a 5% increase for physicians, APRNs, PAs, clinics, skilled therapy providers, ambulatory surgical centers, laboratories, dialysis providers, X-ray providers, and DME providers. Additionally, there was a 5.7% dispensing fee rate increase for pharmacies, a 79% rate increase for transportation providers, and a 93% rate increase for dental providers. There was no rate increase for FQHCs. However, there was a 10% baseline rate increase for community behavioral health rates.

The increased reimbursement rates authorized by HB 33 apply to dates of service starting January 1, 2024, and beyond. Note that ODM will reimburse all services based on the date the service was rendered, not the date the provider bills for the service. ODM also reminded providers that, even after the rates are increased due to HB 33, providers must continue to charge their reasonable and customary rates regardless of anticipated reimbursement from the department. ODM’s fee schedules and rates are codified in the Ohio Administrative Code and accessible for providers on ODM’s website.

If you have questions about ODM’s reimbursement rate increases, please contact your local BMD Healthcare Attorneys Daphne Kackloudis at dlkackloudis@bmdllc.com or Ashley Watson at abwatson@bmdllc.com.

Daphne KackloudisAshley Watsonjordan burdickMedicaid
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

Employee or Independent Contractor? New Guidance Issued by the Department of Labor

January 10, 2024On January 9, 2024, the U.S. Department of Labor (DOL) issued its long-awaited final rule — effective March 11, 2024 — revising its prior interpretation of worker classifications under the federal Fair Labor Standards Act (FLSA). The new final rule rescinds the standard previously established in 2021, in turn, shifting the analysis of whether a worker is an employee (versus an independent contractor) of a business from a more streamlined “economic reality” test to a more complex “totality of the circumstances” standard.Client Alert

Corporate Transparency Act Update

December 27, 2023The Corporate Transparency Act (“CTA”), with an effective date of January 1, 2024, is set to impose strict reporting guidelines on business owners throughout the country. The following provides a brief update on two aspects of the CTA ahead of its effectiveness next week.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.
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