Ohio Medicaid seeking bids from qualified managed care organizations
By
-
The Ohio Department of Job and Family Services (ODJFS) announced today that it has issued a request for applications (RFA) from qualified managed care organizations interested in providing service to Ohioans enrolled in Medicaid.
The ODJFS Office of Ohio Health Plans (Ohio Medicaid) currently oversees seven health plans that serve the needs of more than 1.6 million low-income, Medicaid-eligible Ohioans.
“The purpose of managed care is to improve health outcomes for individuals enrolled in the Medicaid program,” said Ohio Medicaid Director John McCarthy. “As our partners, managed care organizations are expected to improve health outcomes by ensuring access to care and providing intensive case management services to those individuals who have the highest need and often the most complex medical and social conditions.”
The RFA is part of Ohio Medicaid’s commitment to paying for performance and value, which was a hallmark of the Medicaid reforms in the Jobs Budget (House Bill 153), which saved taxpayers $1.5 billion and will improve care for vulnerable Ohioans.
Ohio Medicaid will evaluate managed care plans that respond to the RFA based on their past performance in coordinating care and providing high-quality health outcomes.
Ohio Medicaid will also use new managed care contract language that is based on model health plan contract language created by Catalyst for Payment Reform, a national, nonprofit organization dedicated to achieving better and higher-value health care. The new contracts will increase expectations regarding the national performance standards managed care plans must meet to receive financial incentive payments, and plans will be required to develop incentives for providers that are tied to improving quality and health outcomes for enrollees.
The new agreements reduce the number of service regions from eight to three and combine coverage for the Aged, Blind and Disabled (ABD) and Covered Families and
Children (CFC) populations in each region.
This new design:
• Increases individual choice and competition, because larger service regions will allow Ohio to offer beneficiaries four plan choices, up from two or three currently, while preserving the relationships beneficiaries have with their doctors and other medical professionals.
• Delivers efficiencies and program improvements envisioned in the state budget, because operating with fewer service regions reduces the administrative burden on the state and on managed care plans and increases competition in the managed care marketplace.
Through the RFA process, ODJFS will select a limited number of applicants to enter into Medicaid managed care provider agreements with the state of Ohio. Eligible RFA applicants will be qualified managed care organizations that best demonstrate the ability to offer the required health care services, agree to meet Ohio’s program specifications, and ensure accountability and cost-effectiveness.
The population to be served under the RFA includes approximately 1.6 million individuals enrolled in Ohio’s CFC program, 125,000 enrolled in the state’s ABD program, and 37,000 children with special needs. Ohio’s Medicaid program serves more than 2.1 million low-income Ohioans. Enrollment under the new contracts is expected to begin January 1, 2013. To view the RFA, go to http://jfs.ohio.gov/RFP/.
[[In-content Ad]]
The ODJFS Office of Ohio Health Plans (Ohio Medicaid) currently oversees seven health plans that serve the needs of more than 1.6 million low-income, Medicaid-eligible Ohioans.
“The purpose of managed care is to improve health outcomes for individuals enrolled in the Medicaid program,” said Ohio Medicaid Director John McCarthy. “As our partners, managed care organizations are expected to improve health outcomes by ensuring access to care and providing intensive case management services to those individuals who have the highest need and often the most complex medical and social conditions.”
The RFA is part of Ohio Medicaid’s commitment to paying for performance and value, which was a hallmark of the Medicaid reforms in the Jobs Budget (House Bill 153), which saved taxpayers $1.5 billion and will improve care for vulnerable Ohioans.
Ohio Medicaid will evaluate managed care plans that respond to the RFA based on their past performance in coordinating care and providing high-quality health outcomes.
Ohio Medicaid will also use new managed care contract language that is based on model health plan contract language created by Catalyst for Payment Reform, a national, nonprofit organization dedicated to achieving better and higher-value health care. The new contracts will increase expectations regarding the national performance standards managed care plans must meet to receive financial incentive payments, and plans will be required to develop incentives for providers that are tied to improving quality and health outcomes for enrollees.
The new agreements reduce the number of service regions from eight to three and combine coverage for the Aged, Blind and Disabled (ABD) and Covered Families and
Children (CFC) populations in each region.
This new design:
• Increases individual choice and competition, because larger service regions will allow Ohio to offer beneficiaries four plan choices, up from two or three currently, while preserving the relationships beneficiaries have with their doctors and other medical professionals.
• Delivers efficiencies and program improvements envisioned in the state budget, because operating with fewer service regions reduces the administrative burden on the state and on managed care plans and increases competition in the managed care marketplace.
Through the RFA process, ODJFS will select a limited number of applicants to enter into Medicaid managed care provider agreements with the state of Ohio. Eligible RFA applicants will be qualified managed care organizations that best demonstrate the ability to offer the required health care services, agree to meet Ohio’s program specifications, and ensure accountability and cost-effectiveness.
The population to be served under the RFA includes approximately 1.6 million individuals enrolled in Ohio’s CFC program, 125,000 enrolled in the state’s ABD program, and 37,000 children with special needs. Ohio’s Medicaid program serves more than 2.1 million low-income Ohioans. Enrollment under the new contracts is expected to begin January 1, 2013. To view the RFA, go to http://jfs.ohio.gov/RFP/.
[[In-content Ad]]