Community Medicaid
Ohio’s Community Medicaid mental health program is managed by the Ohio Department of Mental Health (ODMH) Office of Medicaid. While the Ohio Department of Job and Family Services offers assistance to consumers applying for Medicaid benefits, the ODMH Office of Medicaid works with county mental health boards to assure that state Medicaid requirements are met by those providing mental health services to consumers. The Office of Medicaid staff strives to better serve the mental health community by balancing the needs of Ohio’s publicly funded behavioral health system with federal and state payer requirements.
Recent Announcements
Reinstatement of Medicaid for Public Institution Recipients (RoMPIR) Project
Prior Authorization Exemption for Psychiatrists
The documents in this section relate to the Ohio Department of Job and Family Services, Office of Ohio Health Plans revised policy for covering certain second generation anti-psychotic medications prescribed to aged, blind or disabled clients enrolled in Medicaid managed care plans. Under the revised policy, psychiatrists contracting with managed care plans or working through a community mental health center (CMHC) may be exempt from prior authorization requirements for current and future second generation anti-psychotics without an available generic, bio-equivalent or metabolite.
- Reminder: Managed Care Prior Authorization Exemption for 2nd Generation Anti-Psychotic Prescriptions
- Managed Care Prior Authorization Exemption for 2nd Generation Anti-Psychotic Prescriptions
- Psychiatrist Data Specifications Spreadsheet (Revised 11/08)
National Provider Identifier (NPI) for Crossover & Risperdal
The National Provider Identifier (NPI) for Crossover & Risperdal documents in this section relate to the process that community mental health agencies must follow to ensure proper Medicare/Medicaid crossover payments and risperdal payments. The process is due to the implementation of the National Provider Identifier (NPI) system. The NPI is a unique health provider identifier on standard electronic health care transactions. It simplifies exchange of health care data by eliminating the need for health care providers to use different identification numbers to identify them when conducting standard transactions with multiple health plans.
Certified Public Expenditure Process
This process is used by boards to demonstrate the source of funds (Medicaid expenditures) used to pay for Medicaid-covered behavioral health services delivered by providers of alcohol and other drug treatment and/or mental health services.
- ODADAS and ODMH Web-Based Modified Certified Public Expenditure (CPE) Application Update and Invitation
- State Fiscal Year (SFY) 2009 Community Medicaid Financing Information (large file)
- Forthcoming Proposed Changes for Behavioral Health in Ohio from Ohio Department of Job & Family Services, Ohio Department of Mental Health and Ohio Department of Drug and Alcohol Services
- Behavioral Health System Reform April 2008 Update
ODMH Certified Agencies & Satellites
- ODMH Certified Agency & Satellite List by County Guide
- ODMH Certified Agency & Satellite List by County
- Inpatient Psychiatric Hospital Provider List
Medicaid Agreements for FY 08 and FY 09
- Ohio Department of Job & Family Services (ODJFS) Medicaid Provider Agreement Letter
- Community Medicaid Agreements and Board/Agency List Letter
- Community Medicaid Services Agreement Between The Ohio Department of Mental Health and ADAMH/CMH Boards
- Community Medicaid Services Agreement Between ADAMH/CMH Boards and Community Mental Health Agencies
Board/Agency Exhibits
- FY 09 Interagency Agreement between ODJFS & ODMH A-89-07-1319 - Exhibit A
- FY 08 Interagency Agreement between ODJFS & ODMH A-89-07-0399 - Exhibit A
- FY 06 Interagency Agreement between ODJFS & ODMH A-67-07-0524 - Exhibit A
- FY 06 Interagency Agreement between ODJFS & ODMH A-67-07-0524 - Amendment No. 1 - Exhibit A
- FY 06 Interagency Agreement between ODJFS & ODMH A-67-07-0524 - Amendment No. 2 - Exhibit A
- FY 04-05 Community Medicaid Rate Ceilings - Exhibit D
- Ohio Health Plans Provider Enrollment Application/Agreement for Organizations - Exhibit E (Rev. 04/2008)
- Form W-9 - Exhibit E (Revised October 2007)
- Declaration Regarding Material Assistance/Non-assistance to a Terrorist Organization (DMA) - Exhibit E (July 2006)
- List of Community Medicaid Contract Agencies - Exhibit I (updated 1/07/09)
SFY 2010 Community Medicaid Rate Information
- Rate Sheet Letter and Instructions
- Mental Health Services Community Medicaid Rate Sheet
- Mental Health Services Community Medicaid Rate Sheet
- Uniform Cost Report with Formulas (DMH-FIS-047)
- Uniform Cost Report without Formulas (DMH-FIS-047)
- Medicaid Fee Schedule and Reconciliation Rules Update for Alcohol and Other Drug (AoD) Treatment and Mental Health (MH) Services
Training Materials
- FAQs about the ODMH Community Audit Program
- O.A.C. 5101:3-27-06 Training on Medicaid Compliance and Medical Necessity Documentation Reviews, August 2007
- 3/30/06 Memo for Implementation of OAC rule 5101 : 3-27-05 Provisions Related to Partial Hospitalization Services
- Medicaid Rate Setting Reimbursement & Reconciliation Rules Training, January 2006
- Uniform Cost Report Rules and Training Materials, January 2005
Rules and Guidelines
- ODJFS Community Mental Health Agency Services Rules and Guidelines 5101:3-27
- ODADAS-ODMH Guidelines Pertaining to the Implementation of MACSIS under HIPAA, Effective July 1, 2003 (Last Updated January 27, 2005)
- Analysis of Federal Medicaid Requirements
- Audit Guidelines
Memorandum of Understanding (MOU) Steering Committee
The purpose of the Memorandum of Understanding (MOU) Steering Committee is to work collaboratively to resolve a number of systems issues. The group was initially formed as a result of a settlement reached in litigation.
Medicare Part D
The Medicare Modernization Act (MMA), enacted in 2003, established a new benefit for Medicare prescription drug coverage, Medicare Part D. All Medicare beneficiaries are eligible for drug coverage under a Medicare prescription drug plan. These plans cover both brand names and generic drugs. And, very importantly, there is extra help for those in need.