MyCare Ohio, a new managed care program for Ohioans who receive both Medicare and Medicaid benefits, will roll out starting July 1 for Homecare and Hospice patients residing in the Northeast region of Ohio. MyCare Ohio is a three year demonstration project developed to determine the ability of the State to better manage the care and costs of Medicare/Medicaid recipients.A total of 29 countiesare affected. Home Health and Hospice agencies should immediately begin to learn about the program details specific to HHAs and Hospices and to initiate dialogue with the insurance carriers for their region. HHAs and Hospices will need to contract with the Managed Care Plans.
"I anticipate that the plans may have a lot of influence over the choice of hospices that are used in nursing facilities," says Jeff Lycan, President & CEO of Midwest Care Alliance. "Hospices need to ask themselves, 'What is the goal of the health plans in meeting their outcomes with the Department of Medicaid?' and 'How can hospices help those plans achieve those goals?'" A good example of a goal agencies should pursue is reducing re-hospitalizations. "Hospices assist SNFs in providing better symptom management so that a patient doesn't have to be transferred to a hospital to receive the care they need."
Hospices that do not currently useelectronic health records(EHR) are advised to have a program implemented at their organization. "If you have EHR with the ability to do telehealth, you may have an advantage to suggest how to help care for your patient," says Lycan. "You may be able to help in a manner that Medicaid would not have allowed in the past as the plan now becomes the payer of the services. If a hospice can put together a program and demonstrate its value, the agency can potentially have a better opportunity to 'sell or market' itself to the health plan."
Providers should be completing the following initiatives:
Identify all patients required to enroll in MyCare Ohio
Verify health plan enrollment for both Medicare and Medicaid for affected patients
Contact all MyCare Ohio insurance plans and have a contract finalized or in process
Obtain authorizations for any Medicare residents who enrolled in the Medicare benefit of the Health Plan
Secure a clearinghouse for your claim submission
Create new payer classifications within your billing software