Opportunity Detail

Questions and Answers

Ohio Medicaid Managed Care Program RFI #2
Document #:  ODMR20210019


Question:   In question 17 – Centralized Credentialing, is “provider” in this section referencing physicians only?

Answer:   No, ODM will be credentialing all providers that require credentialing based on CMS and NCQA standards.

Date: 2/24/2020

Inquiry: 71902


Question:   1. Does the Ohio Department of Medicaid (ODM) intend to publicly release the full responses to the June 2019, Request for Information (RFI #1) that was directed toward individuals receiving Medicaid services and their families, advocates for individuals, providers, provider associations, partner state agencies, and other persons or organizations with relevant information, opinions, and experiences? 2. For question #17 regarding Centralized Credentialing: has ODM developed a proposed work flow outlining the operational procedures of the new centralized credentialing process? Would the centralization occur through an electronic repository or portal? 3. For section #18 regarding Provider Requirements: In addition to the need to apply ASAM criteria for SUD, will ODM be creating their own medical necessity criteria for other services or will MCOs be required to utilize another established set of clinical criteria/guidelines? 4. What is the timeline for choosing the fiscal intermediary, care coordinating entities (CCEs) and single PBM referenced in RFI #2? Will vendor selections occur before or after the MCO RFP? 5. With regard to section 4 – Fiscal Intermediary, we have the following questions: a. What level of SNIP editing will be applied? b. Will member eligibility be edited and claims denied/returned to providers or forwarded to MCO with last active eligibility segment? c. What elements of the provider (rendering and billing) will be edited? d. How will claims providers submit via paper be handled? 6. For question 12 Care Coordination subsection b., data and communication are essential. In the effort to standardize across plans, does ODM envision an IT/Data sharing system? 7. Question 13 states that "Regionally-located Care Management Entities will serve as the “locus of accountability” for children with complex challenges and their families who are involved in navigating multiple state systems. The Care Management Entities will be responsible for providing and/or coordinating the provision of intensive care coordination, community-based services, and other services and supports to improve health outcomes." a. Is there an existing infrastructure of Care Management Entities ODM envisions fulling the role of Care Management Entities? What credentials will be required of Care Management Entities?

Answer:   The responses were posted to the ODM managed care procurement website on February 18, 2020. ODM will be seeking input from MCPs to design workflow and a hand-off of information. The centralization of credentialing activities will occur through ODM's new Provider Network Management (PNM) module (system). Providers will enter through a portal and ODM will maintain provider screening, enrollment and credentialing information in its PNM system. As indicated, ODM is considering the requirements listed in question 18 and invites respondents' feedback. ODM has not yet determined the exact release and implementation dates. but intends that selections, readiness, and implemntation will be completed in a coordinated fashion. (a) The SNIP level has not been determined yet. (b) Member eligibility will be checked before the claim is either denied/returned to the provider or forwarded to the MCO. (c) Both rendering and billing provider will be edited. (d) The FI will not allow for paper claims. Only EDI and claims submitted via the FI portal will be accepted. ODM welcomes feedback regarding IT, data, and communication necessary for care coordination, per question 12 part d. The Care Management Entity model is still under development. ODM welcomes feedback regarding infrastructure, credentials, and other aspects that would be helpful in developing the model.

Date: 2/24/2020

Inquiry: 71901


Question:   In order to best respond to the questions included in the “Pharmacy Benefits Management” section of the RFI, we would like to request additional clarity on the pharmacy model that ODM is proposing in the RFI. Does ODM envision that the pharmacy benefit would be carved-out of managed care? Clarity on ODM’s direction will help us provide more relevant and comprehensive answers to the questions posed in this section.

Answer:   ODM has yet to make this determination.

Date: 2/24/2020

Inquiry: 71900


Question:   Regarding question 17: - For centralized credentialing, will the Credentials Verification Organization (CVO) be NCQA accredited? - Will the implementation of the CVO be commensurate with the new MCO contracts effective date?

Answer:   Yes, the CVO will be NCQA accredited. ODM will be implementing Centralized Credentialing in tandem with the anticipated go-live date of the Provider Network Management Module.

Date: 2/24/2020

Inquiry: 71899


Question:   Regarding question 14: - How does ODM envision the BH ASO coordinating care with the primary care provider?

Answer:   Yes, there will be a separate procurement for the BH-ASO. The timeline for this procurement is not yet known.

Date: 2/24/2020

Inquiry: 71898


Question:   Regarding question 13: - How will the BH ASO entity be determined? Will there be a separate BH ASO RFP process? What is the timing of this process?

Answer:   ODM also welcomes feedback regarding expectations for Care Guides, per question 12 parts g and h.  The process for selecting the BH-ASO is still under development.

Date: 2/24/2020

Inquiry: 71897


Question:   Regarding question 12: - Will ODM be setting up a data sharing infrastructure for CCEs, MCOs and other community-based care coordinators? - What are ODM’s expectations for Care Guide language access and access among persons with disabilities?

Answer:   ODM welcomes feedback regarding IT, data, and communication necessary for care coordination, per question 12 letter d.

Date: 2/24/2020

Inquiry: 71896


Question:   Regarding question 7: - 7b: If ODM ultimately elects a coordinated, statewide approach, does it anticipate it already possesses the administrative capabilities to support such an approach and would it need to obtain these separate from the MCOs? - 7c: Is ODM open to outcome metrics based on access, cost, and quality and is one or more of these areas a priority above others for ODM?

Answer:   ODM invites respondents' comments in response to these considerations.

Date: 2/24/2020

Inquiry: 71895


Question:   Regarding question 6: - Will ODM identify CBOs it wishes MCOs to partner with or will they require MCOs to propose community partnerships in the response? - Will local health departments be acceptable health and wellness partners? - Will the state be requiring MCOs to collaborate or to align benefits or incentive programs? - Will the state be requiring MCOs to use a specific social risk screening tool or navigation resource? - Would the collaboration be on a state-sponsored program or on an MCO unified program?

Answer:   ODM is in the process of developing the request for applications and cannot answer any question specific to its contents at this time. However, ODM intends that the MCOs collaborate with each other and the State to support a collective impact approach.

Date: 2/24/2020

Inquiry: 71894


Question:   Regarding question 5: - Can ODM provide its thoughts on the assignment algorithm and how they will potentially measure health plan quality as part of any quality-based assignment algorithm? - Can ODM provide its thoughts on looking to reduce the number of MCOs or expanding MCOs? Will there be limited number of MCOs per region? - Can ODM provide its thoughts on how it intends to initially redistribute members for Day 1 enrollment under the new contract? What initial membership considerations will be made for new plans entering the program? Will there be a full redistribution of the initial membership equally amongst the plans as other states have done?

Answer:   ODM has not yet made a determination on these issues. It looks forward to the respondents' responses to this RFI.

Date: 2/24/2020

Inquiry: 71893


Question:   Regarding question 4: - Will there be a separate RFP/RFA to select the Fiscal Intermediary (FI)? If so, what is the timing of this RFP/RFA and will the implementation be commensurate with the effective date of the new MCO contracts? - What type of organization can be an FI and can it be an MCO? - Will the FI deploy any edits beyond the SNIP edits, such as Ohio Medicaid policy specific edits or National Correct Coding Initiative edits? - Can you describe the code editing process being considered by ODM for use by the FI and to what degree plans will have the ability to add their own code edits that align with their medical policies? Will ODM or the fiscal intermediary be involved in plan-specific medical policies or code edits? - Will there be documented turnaround times that the FI must adhere to for UM, claims, and claims disputes? If so, will the turnaround times differ for standard versus urgent requests? - Will the FI be involved in making utilization management decisions? o If so, in instances where clinical collaboration is needed, what is ODM’s current thinking on how this process will be managed and the role of the FI in that process? o If so will the FI be using Milliman Care Guidelines or InterQual guidelines in addition to ODM policies in the utilization management process? o If so, can MCO’a appeal decisions made by the fiscal intermediary? - Will the FI be able to store and respond to differences in prior authorization programs across MCOs?

Answer:   The FI will be a separate procurement opportunity that is still under development. The requirements for an entity to submit a bid for the FI contract will be included in that procurement. While policy considerations regarding the FI are still under development, ODM will reserve the right to implement any Ohio Medicaid policy specific edits it determines necessary. Absent an ODM requirement to the contrary, each MCO will be able to adjudicate claims according to this own payment policies. Plan-specific medical policies and code edits may not be inconsistent with Ohio Medicaid policy. The FI will be required to meet strict timelines for processing for all claims. The FI will not be involved in making utilization management decisions. Except as otherwise required by ODM policy, prior authorization programs for each MCO will remain the MCO's responsibility; however, the MCO will be required to report the outcome of all prior authorization determinations back to the FI.

Date: 2/24/2020

Inquiry: 71892


Question:   Regarding question 3: - The RFI states that the PBM and ODM will be responsible for integrating medical and pharmacy claims. Please provide more context/information regarding what integrating means. - Would the value-based payments for pharmacies be contracted through and administered by the PBMs, the health plans, or both? - Will ODM define which drugs are paid for on the medical side (versus the pharmacy side)? - Would a common formulary and prior authorization criteria exist for drugs on the medical side? - How will the PBM RFP timing align with the managed care plan RFA?

Answer:   1. Integration involves insuring 2-way data connections to allow both pharmacy and medical claims to flow to various providers for various purposes 2. ODM has yet to make this determination. 3. ODM has yet to make this determination. 4. ODM has yet to make this determination. 5. ODM has yet to make this determination.

Date: 2/24/2020

Inquiry: 71891


Question:   Could ODM expand on the timeline on page 5 with respect to the anticipated RFA release date and expectations for a go-live date for the new managed care contracts?

Answer:   ODM has not yet determined the exact release and implementation dates.

Date: 2/24/2020

Inquiry: 71890


Question:   Will Recovery Ohio be assisting ODM in the administration of various programs in addition to the agencies stated in the RFI?

Answer:   Since its inception, Recovery Ohio has been and will continue to be one of ODM's many partners in the development and administration of the Medicaid program.

Date: 2/24/2020

Inquiry: 71889


Question:   Part 2: 16. Regarding Question 17 Centralized Credentialing, will managed care organizations be required to have an agreement in place recognizing ODM as a “delegate” for other products than Medicaid (e.g. Medicare, exchange, commercial, etc.)? 17. Regarding Question 17 Centralized Credentialing, will ODM follow all NCQA standards, including assuming responsibility for ongoing sanction reviews to comply with NCQA standard CR 5: Ongoing Monitoring and Interventions? 18. If ODM contracts with a Credentials Verification Organization (CVO) for centralized provider credentialing and re-credentialing, what impact would this have on managed care organizations existing delegated credentialing contracts? This question applies to both a MCOs contracted provider network and their subcontractors network? 19. Regarding Question 17 Centralized Credentialing, will ODM be contracting with a Credentials Verification Organization (CVO) on behalf of the managed care organizations (MCOs) or will MCOs be required to contract with the selected CVO independently? 20. If ODM contracts with a Credentials Verification Organization (CVO) for centralized provider credentialing and re-credentialing, will the managed care organizations retain flexibility in network design as they do under the current managed care plan provider agreement? 21. Regarding Question 19 Workforce Development, can ODM please confirm that this question is in reference to supporting the healthcare workforce pipeline and addressing healthcare professional shortages? If this assumption is not correct, can ODM please clarify the intent of the question? 22. Regarding Question 21.e, is ODM referring to a potentially new process for updating MCO eligibility, e.g. to replace the existing scheduled 5 day a week 834 file updates from ODM to managed care organizations? Any clarification will aid respondents to provide feedback to ODM.

Answer:   No, ODM will be the sole entity, through its CVO, to complete credentialing for all providers participating in Ohio Medicaid. MCPs will be required to accept ODM's credentialing results and will be prohibited from engaging providers in additional or secondary credentialing processes or activities. Yes, ODM and its CVO will comply with NCQA standards. MCPs delegated credentialing contracts will be obsolete and unnecessary once ODM and its CVO assume the centralized credentialing role. ODM will be contracting with a CVO and it will not be necessary for the MCPs to have their own contract with that CVO. There will be language in the MCP Provider Agreement that clarifies or defines this relationship. The MCPs will be able to contract with any provider credentialed by ODM. MCPs will retain flexibility in their network contracting processes. This question is specifically in reference to addressing Medicaid provider workforce concerns. The respondent should make its best effort to answer the question in light of its experience and the context provided, including addressing whether existing processes are sufficient and why or why not.

Date: 2/24/2020

Inquiry: 71888


Question:   1. In regards to Question 3.d, given that MyCare Medicaid pharmacy benefit only covers over the counter drugs, can ODM provide further explanation on what they envision would be managed by the pharmacy benefit manager for this population? 2. If ODM chooses to engage with a single pharmacy benefit manager, will the managed care organizations continue to be at risk for pharmacy or will ODM be contracting with a single PBM as a prepaid ambulatory health plan (PAHP) and that PAHP would accept risk? 3. If ODM chooses to engage with a single pharmacy benefit manager (PBM), will ODM be contracting with the PBM on behalf of the managed care organizations (MCOs) or will MCOs be responsible for contracting with the identified PBM? If ODM will be contracting with the PBM on behalf of the MCOs, will that include determination of fee schedules with the PBM? 4. Regarding Question 3, does ODM envision that the managed care organization will also be responsible for physician administered drugs (e.g. oral and parental drugs)? If that assumption is incorrect, please clarify. 5. Question 4 Fiscal Intermediary states that, “The MCO will be required to provide status updates to the fiscal intermediary to report to the provider before adjudication.” Can ODM please clarify what would be included in “status updates” prior to adjudication and the frequency of required “status updates”? 6. Question 4 states, “The MCO will provide data back to the fiscal intermediary for the 835 Electronic Remittance Advice and a “paper” Remittance Advice for the Provider Portal.” With respect to the “Provider Portal” referenced in the above sentence: Does ODM intend that this Provider Portal be operated by the fiscal intermediary on behalf of all managed care organizations, and that providers could submit claims online via this same Portal? Please clarify. 7. Question 5 Enrollment states that “ODM intends to redistribute individuals who do not affirmatively select an MCO”. Given this statement, does ODM intend to require all members to re-select their managed care plan at the beginning of the new contract period following the request for application (RFA) process? Or does ODM intend to hold an open enrollment prior to the start of the new contract following the RFA process? 8. Under the care coordination model outlined in Question 12, who will be responsible for preforming oversight of the CCEs? 9. Under the care coordination model outlined in Question 12, would ODM require managed care organizations (MCOs) to contract with all CCEs designated by ODM or will MCOs have flexibility to choose which CCEs they contract with? 10. Under the care coordination model outlined in Question 12, how does ODM envision CCEs being reimbursed? Does ODM envision CCEs assuming risk? 11. Regarding Question 12 Care Coordination, can ODM please explain/define “time limited MCO problem solving capabilities”? 12. Regarding Question 13, can ODM define the criteria that would qualify a child or youth as having “complex behavioral health needs”? In addition, who would be responsible for making the determination that children/youth meet the criteria? 13. Question 17 Centralized Credentialing states “MCO responsibilities will include…notifying ODM of denied provider applications”. We assume this means a denied “contract” since ODM will be approving/denying credentialing applications? If that assumption is incorrect, please explain. 14. If ODM contracts with a Credentials Verification Organization (CVO), will ODM be considered a “contracting entity” under Ohio Revised Code 3963.01(D) and required to comply with NCQA and the credentialing standards in Ohio Revised Code 3963.05 and 3963.06? 15. Regarding Question 17, Centralized Credentialing, does ODM envision the centralized credentialing would apply only to Medicaid providers? If yes, how would this affect providers who participate in both Medicaid and Medicare?

Answer:   The claims for all MCO providers other than pharmacy claims will be submitted through the FI portal. The single pharmacy benefit manager will have a separate portal for pharmacy claims. ODM has not finalized the process for redistributing individuals. It will likely include an open enrollment period prior to the start of the new contract. ODM welcomes feedback on the roles and responsibilties of MCOs, CCEs, and other parties, per question 12 part a. ODM welcomes feedback on the CCE entities and their relationships with MCOs, per question 12 parts a through d. The RFI mentions example types of Care Coordinating Entities. ODM welcomes feedback on the CCE entities and responsibilities, per question 12 parts a and b. The respondent should make its best effort to answer the question in light of its experience and the context provided. The BH-ASO is still under development. ODM welcomes feedback on this aspect of the model, per question 13 parts a and b. Yes, this means a denied contract. ODM intends to receive information from MCPs about providers that have been contracted with the Managed Care Plan. MCPs will continue to be the contracting entity with their provider networks. ODM is assuming a centralized credentialing role only. ODM will be abiding by requirements specified in ORC 3963.05 regarding credentialing application forms. ODM's CVO will follow ORC 3963.06 regarding credentialing time frames. ODM is only credentialing participating Medicaid providers. It is likely that some of these are also Medicare providers. ODM intends to comply with CMS credentialing requirements.

Date: 2/24/2020

Inquiry: 71887


Question:   12. In paragraph 2 of #12, it discusses existing care coordination structures through DoDD, PASSPORT, etc.. With specific regard to DoDD, it is assumed that the existing structure being referred to is the SSA role within the county boards’ staff. While the SSAs perform a vital function in linkage to identified services, the SSAs do not typically take a population health or health improvement approach to care coordination work. Is ODM open to the concept of a provider led structure of care coordination that complements the work of the SSAs within DoDD which goes beyond linkage to needed services and is specifically focused on health improvement activities? 13. In the proposed model, does ODM envision that a regional Care Management Entity could serve multiple regions if they are regionally located in multiple regions? 13. Is it proposed that the BH-ASO contract to manage the behavioral health needs only or, since these children are often involved with multiple state systems, to also manage the IDD needs that are funded through the state budget (ex. ICF-IDD and Self-Waivers)? 13. Is there a current website or list that indicates the “pre-requisite competencies for Intensive Care Coordination Using High Fidelity Wraparound”? 13. In the proposed model, is the regional Care Management Entity the same entity that would provide the Intensive Care Coordination Using High Fidelity Wraparound for the identified children? 13. In the proposed model, do regional Care Management Entities only serve children whose complex behavioral health needs or multi-system involvement needs indicate enrollment in the BH-ASO or do regional Care Management Entities also serve children who have less intense behavioral health needs and so are only enrolled in an MCO—not the BH-ASO?

Answer:   ODM welcomes feedback on the roles and responsibilties of MCOs, CCEs, and other parties, per question 12 parts a and b. The Care Management Entity model is still under development. ODM welcomes feedback regarding the network of entities, per question 13 part c. The BH-ASO model is still under development. ODM welcomes feedback on the target population for the model, per question 13 part a. The respondent should make its best effort to answer the question in light of its experience and the context provided. Yes The Care Management Entity model is still under development.

Date: 2/24/2020

Inquiry: 71885


Question:   Will ODM accept a cover letter as part of the RFI response?

Answer:   Yes

Date: 2/24/2020

Inquiry: 71873


Question:   Question - Section VII Response Submission Procedures, pg. 20 When will responses to RFI #2 be made public? Will ODM be providing a formal comments on responses received?

Answer:   ODM has not determined when responses to RFI #2 will be made public, but anticipates doing so before issuing the managed care organizations procurement opportunity. ODM does not intend to provide formal comment on the responses received, but the responses will be taken into consideration as ODM develops the procurement opportunity.

Date: 2/24/2020

Inquiry: 71872


Question:   Question #18, 1st bullet point, page 17 Please provide information on who developed the state guidelines, credentials, how often are they reviewed and updated, and if they are evidence based. Will the plans have an opportunity to discuss those items ODM deems as prohibited prior authorizations as determined by ODM?

Answer:   The items listed in question 18 are under consideration and have not been implemented. ODM looks forward to your responses to the RFI.

Date: 2/24/2020

Inquiry: 71871


Question:   Question #17, page 17 Will ODM be responsible for all credentialing and re-credentialing or would a vendor preform these functions? Will ODM/vendor follow all NCQA credentialing and re-credentialing requirements? This could be ideal but the Managed Care Plan has concerns with the integrity of the data in the current Provider Master File (PMF).

Answer:   ODM has contracted with a vendor that will be obligated to follow all applicable NCQA credentialling and re-credentialling requirements. The vendor is NCQA certified for credentialing and re-credentialing. Additionally, ODM is working with vendor to develop and implement a new provider module, which should provide opportunity to update the PMF or an equivalent data source that better meets MCP needs.

Date: 2/24/2020

Inquiry: 71870


Question:   Question #14 (c), page 16 What is meant by functional outcomes?

Answer:   The respondent should make its best effort to answer the question in light of its experience and the context provided.

Date: 2/24/2020

Inquiry: 71869


Question:   Question #14, page 16 Will ODM provide any assurances that help protect BH services from closing their doors from revenue loss?

Answer:   The BH-ASO model is still under development, and the concern is noted.

Date: 2/24/2020

Inquiry: 71868


Question:   Question #13, page 14 Can you be more specific about the role the MCOs would play with the BH-ASOs?

Answer:   The BH-ASO model is still under development.

Date: 2/24/2020

Inquiry: 71867


Question:   Question #12, page 12 Would the “Care Guides” be a lower or higher level of Care Management than the current Case Management program?

Answer:   The Care Guide function is distinctly different from the longitudinal care managment functions that exist in the current program.

Date: 2/24/2020

Inquiry: 71866


Question:   Question #12, page 12 Would the CMHC system be considered Care Coordinating Entities (CCEs)?

Answer:   ODM welcomes feedback on the roles and responsibilities of MCOs, CCEs, and other parties per question 12 parts a and b.

Date: 2/24/2020

Inquiry: 71865


Question:   Question #11, page 12 Does this question also included safety for members (i.e., car seats for small children)?

Answer:   The respondent should make its best effort to answer the question in light of its experience and the context provided.

Date: 2/24/2020

Inquiry: 71864


Question:   Question #11, page 12 Will feedback/recommendations from third party vendors (e.g., dental, transportation, etc.) be accepted through the RFI #2 process, either directly from the third party vendor or through a contracted MCO?

Answer:   ODM welcomes feedback from third-party vendors either directly or through a contracted MCO.

Date: 2/24/2020

Inquiry: 71863


Question:   Question #10, page 11 Will feedback/recommendations from third party vendors (e.g., dental, transportation, etc.) be accepted through the RFI #2 process, either directly from the third party vendor or through a contracted MCO?

Answer:   ODM welcomes feedback from third-party vendors either directly or through a contracted MCO.

Date: 2/24/2020

Inquiry: 71862


Question:   Question #9 (a), page 11 Please define work-ready.

Answer:   The respondent should make its best effort to answer the question in light of its experience and the context provided.

Date: 2/24/2020

Inquiry: 71861


Question:   Question #5, page 10 What is the definition of “affirmatively”? How will the rebid final decision change the way FFS is managed?

Answer:   Unless an individual or his or her authorized representative actively selects an MCO assignment, the individual will be automatically assigned. The management of fee-for-service Medicaid is not included in the scope of this procurement, at this time.

Date: 2/24/2020

Inquiry: 71860


Question:   Question #4 (b), page 10 The Managed Care Plan identified the following disadvantages of requiring the MCO to comply with/apply fee-for-service claims processing edits and rules • Potential file transfer issues for either inbound or outbound • How do we track days between outbound/inbound files that add to Prompt Pays days • Are these rules applied or not applied should we have a provider agreement otherwise • Claims can deny inappropriately if the Fiscal Intermediary auth file is not matched before the claim is processed • Using a Provider Master File, that is not updated daily back/forth, can lead to HIPAA compliance issues with paying incorrect providers/address etc.

Answer:   The managed care organization should describe its concerns in its response to the RFI and not through this question and answer process.

Date: 2/24/2020

Inquiry: 71859


Question:   Question # 4 (a), page 10 Would the fiscal intermediary make any type of determination i.e. whether or not the information submitted is adequate to make a determination? Or would the fiscal intermediary forward everything they received without any type of review process?

Answer:   The fiscal intermediary will edit the claim to specific Strategic National Implementation Process (SNIP) level edits; if the fiscal intermediary is unable to do so the claim will be returned and not forwarded to the managed care organization.

Date: 2/24/2020

Inquiry: 71858


Question:   Question #4, page 9 Will there be a guaranteed turnaround time for the fiscal intermediary? What will the process be to monitor the accuracy and timeliness of the intermediary? The Managed Care Plan has a concern of claims possibly denying for no authorization if the prior authorization is not completed before receipt of the claim.

Answer:   The business requirements for the Fiscal Intermediary are still under development, and the concern is noted.

Date: 2/24/2020

Inquiry: 71857


Question:   Question #4, page 9 Would the Fiscal Intermediary or the Managed Care Plan mail Explanation of Payments (EOPs) to the providers?

Answer:   The managed care organization will mail the explanation of payments to providers for any claim adjudicated by the managed care organization.

Date: 2/24/2020

Inquiry: 71855


Question:   Question #4, page 9 The Managed Care Plan would like clarification on the term Provider Portal. Does this refer to the MCO provider portal or ODM’s MITS portal? Would ODM require the MCOs to continue to maintain their own provider portal, or is provider to be directed to MITS instead?

Answer:   All MCO provider claims other than pharmacy claims will be required to come in through the fiscal intermediary. MCOs will not be required or permitted to accept claims via their own portal.

Date: 2/24/2020

Inquiry: 71854


Question:   Question #4, page 9 The Managed Care Plan (MCP) would like clarification on how the use of the Fiscal Intermediary (FI) will affect prompt pay calculations. Will the MCP prompt pay claim received date and paid date be impacted by the use of the FI?

Answer:   The prompt pay rules will still apply. Under nearly all circumstances, the managed care organization will receive the claim on the same day that it was submitted to the fiscal intermediary.

Date: 2/24/2020

Inquiry: 71853


Question:   Question #4, page 9 Will the MCPs be able to apply HIPAA or other editing rules to claims received from the Fiscal Intermediary?

Answer:   After a claim is received by the fiscal intermediary, the managed care organization shall adjudicate the claim according to its claims payment rules and any applicable ODM policy. It may not take any other action that would unnecessarily delay the adjudication of a claim.

Date: 2/24/2020

Inquiry: 71852


Question:   Question #3, page 8 Under the single Pharmacy Benefits Manager, would Medicaid consumers still be able to receive Over the Counter (OTC) items under the pharmacy benefit?

Answer:   Yes

Date: 2/24/2020

Inquiry: 71850


Question:   Question #3, page 8 Could ODM clarify how they believe the single pharmacy benefit manager model outlined in this section will be different from a full pharmacy carve out? Pharmacy was carved out from OH Medicaid MCP benefits 2/2010 – 9/2011 and recent financial analyses commissioned by the state showed significant cost increases relating to a pharmacy carve out. Since the General Assembly did not call for a pharmacy carve-out, it would be helpful if ODM could be specific about the differences between the proposed model and a carve-out, as it is not clear based on the language on pages 8 and 9.

Answer:   The pharmacy benefit manager model is under development. The list of activities outlined on pages 8 and 9 is illustrative and it has not yet been determined which of them will be obligations of the managed care organization, pharmacy benefit manager, or both in collaboration.

Date: 2/24/2020

Inquiry: 71849


Question:   Question #3, page 8 Will medical drugs (those given by infusion) be included in the pharmacy benefit?

Answer:   ODM has not yet made this determination.

Date: 2/24/2020

Inquiry: 71848


Question:   Question #2, page 8 Will pharmacy cost/risk be excluded from the contract? Do “all populations” include MyCare?

Answer:   Pharmacy cost/risk will be included in the MCO contract to the extent that the MCO will retain any pharmacy obligations. The managed care procurement does not include a procurement for MyCare.

Date: 2/24/2020

Inquiry: 71847


Question:   Question - Section 1 Stakeholder Feedback/Themes, page 2 Will ODM be holding any listening sessions or in-person interested party meetings prior to the RFI #2 submission deadline?

Answer:   No

Date: 2/24/2020

Inquiry: 71846


Question:   Question - Section 1 General Information, 3rd paragraph, pg. 1 It notes that RFI #2 is NOT the procurement request for applications. Does this mean that ODM has made the decision to use a request for applications methodology for procurement versus as request for proposal methodology? If not, when will that decision be made?

Answer:   The procurement will be a Request for Applications.

Date: 2/24/2020

Inquiry: 71845


Question:   Section VII. Please confirm the incoming email size limit for Respondents submitting their PDF document to ODM_Procurement@medicaid.ohio.gov.

Answer:   The limit for attachments is 50 MB

Date: 2/24/2020

Inquiry: 71817


Question:   21.d Please provide ODM’s definition of “contracted vendors” to allow Respondents to provide applicable best practices.

Answer:   Contracted vendors could include ODM contractors such as managed care organizations, the BH-ASO vendor, the PBM vendor, and the Fiscal Intermediary vendor, as well as other entities such as providers, community based organizations or others that may provide services to indiviudals enrolled in Ohio Medicaid.

Date: 2/24/2020

Inquiry: 71816


Question:   What is the anticipated date in calendar year 2020 for the Ohio Department of Medicaid to release a Medicaid managed care procurement?

Answer:   The release date has not been determined as yet.

Date: 2/24/2020

Inquiry: 71778


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Inquiry period ended:  2/12/2020 8:00:00 AM