Ohio Budget Discussions Continue in the Senate

The Ohio House version of the state budget bill, HB 49, is now in the Ohio Senate for continued debate and discussion. The House version contains various changes to the Medicaid program, including elimination of the Ohio Comprehensive Primary Care (CPC) program.

CPC was developed in 2015 by the Office of Health Transformation, with input from 800+ stakeholders (including 600 clinicians and staff from primary care practices), for use across Medicaid and commercial health insurance statewide. The value-based payment model financially rewards practices that hold down costs by preventing disease and managing chronic conditions. The program’s quality metrics were designed to drive improvement in maternal and infant health, mental health and addiction, and chronic disease.

The House bill eliminates the CPC program and redirects $33 million in state funds over the next two years to other purposes. That action, however, will require the state Medicaid program to do the following:

  • Terminate the CPC program on July 1, 2017.
  • End CPC in the middle of a program year, and repay $9.3 million in federal payments to providers paid to date.
  • Reduce total payments to primary care physicians $123 million over two years.
  • Forfeit $36.1 million in federal grant funds as a result of violating Ohio’s four-year State Innovation Model (SIM) cooperative agreement with the Centers for Medicare & Medicaid Services (CMS) to implement value-based reimbursement.
  • Require taxpayers to spend an estimated $370 million more annually on high-cost Medicaid services in 2020 and beyond that otherwise could have been avoided as a result of better care coordination through the CPC program.

The AMCNO has concerns about the other changes in the bill as well, including limitations to Medicaid enrollments, premiums and work requirements, and removal of funds designated for the Medicaid expansion. The AMCNO does, however, support the requirements for health plans to cover telemedicine services and the requirement that would allow hospital quality committees to have access to records of physicians’ use of the Ohio Automated Rx Reporting System (OARRS).

We will continue to monitor the budget activities and provide additional information as it becomes available. To read more about the bill, click here.

The Pollen Line is now closed. See you in the spring!

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