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Recently, the AMCNO staff attended an Ohio Department of Job and Family Services (ODJFS) Listening Session regarding the Ohio Medicaid Managed Care Plans (MCPs). The session in Cleveland, Ohio was one of five sessions held across the state of Ohio during the summer months.
Over the summer months, the Ohio Department of Job and Family Services (ODJFS) held five public sessions across Ohio seeking input on Ohio’s Medicaid Managed Care Program in order to gain opinions and comments on how to improve Medicaid managed care. Session attendees will be asked to offer ideas about how to:
1. Maximize the cost effectiveness of Medicaid managed care;
2. Improve the quality of services and/or health outcomes for Medicaid consumers enrolled in managed care;
3. Maintain or improve consumer access to needed medical services.
ODJFS plans to utilize comments from the sessions when developing their Medicaid initiatives in Ohio. Each session had a panel that included consumers and members of the ODJFS Medical Care Advisory Committee. Speakers were allotted three minutes to present comments. Presenters included consumers; Medicaid managed care plan representatives, members of the general public and Medicaid providers.
In August, the AMCNO staff attended the session held in Cleveland, Ohio to listen to the comments provided by the presenters. There were many suggestions made by the presenters including the following items:
1.) Simplify and streamline the enrollment process; the current process is too time consuming and costly.
2.) Hold managed care organizations accountable for adhering to plan requirements, increase prompt payment of claims; eliminate some of the red tape to gain prompt payment and resolve outstanding claims and work to obtain timely reimbursements for providers;
3.) Provide information to providers so that they may contact the appropriate person within ODJFS to discuss problem claims in an efficient manner and hold administrative staff accountable for doing their job in a timely fashion (one example was providers put on hold for over 45 minutes to talk to a representative).
4.) Be aggressive with working on preventative care issues, in particular for children in the Medicaid program.
5.) Enhance coordination of services to provide complete and timely care;
6.) There have been many changes in Medicaid Managed Care plans across the state since the inception of the program causing confusion, disruption of care, and inability to continue with a provider. Changes in coverage and contracts need to be better communicated to consumers (i.e. in particular when a large provider does not renew and MCP contract).
7.) Issues continue to arise when a Medicaid patient cannot see a physician of choice if the physician is not contracted with a particular plan.
8.) Review the importance of a medical home concept for Medicaid consumers.
9). Any physician treating children in the MCP program should have access to patient records and the changes in healthcare plans cause confusion. Families of children with chronic health care problems in particular are impacted by these changes.
Staff from the ODJFS indicated that they plan to summarize the comments provided at all of the sessions around the state and these comments will be made available to the participants in the sessions. AMCNO will follow-up with ODJFS to obtain the summary and provide additional information on these sessions to our members.
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