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Waiver Provider News & Updates

Welcome to our Waiver Provider website page. As those servicing some of our most vulnerable Ohioan’s, Buckeye is committed to engaging in meaningful and effective ways to strengthen our partnership in service to these individuals. This page aims to present news, updates and specialty content that is unique and impactful to you.  Be sure to bookmark this page to ensure easy future access.

Click on the link below to view our May 29, 2024, Waiver Provider Townhall. (video may begin as soon as the web page opens - if needed, scroll video back to hear from the beginning)

Townhall FAQs Coming Soon.....

Attend the Waiver Provider Townhall on May 29?

If you attended the Waiver Provider Townhall on May 29 and have not yet completed the brief survey, please complete it now

Buckeye Health Plan is excited to present our new quarterly provider publication Waiver Provider News (WPN). Each quarter, we will have a hot off the press newsletter with the latest and current items you need to know. While the articles and information on this website page may change over time, the content in the newsletter will remain in this archive for future reference. We look forward to growing the WPN, and this website page, through your valuable review and input, ensuring they  provide you value as a resource. 

 

Adult Day Service Transportation

  • Guidance for Adult Day Service Transportation can be found in two places in the Ohio Administrative Code.
    • 173-39-02.1 ODA provider certification:  adult day service which allows providers to bill for transportation separately from the bundled ADS rate.
    • 5160-46-04 Ohio home care waiver:  definition of the covered services and provider requirements and specifications which does not allow for transportation to be billed separately and states that transportation is included in the bundled payments received for ADS.
  • Beginning April 1st, 2024 Buckeye will follow the guidance for ADS transportation outlined in OAC rule 173-39-02.1 which allows ADS providers to bill separately for ADS transportation.
  • A provider may transport each individual to and from the center and be reimbursed according to OAC rule 5160-1-06.1, Adult Day Transportation Round Trip.
  • If a provider choses to render ADS transportation to a Waiver member, this service must be added to the member’s service plan by the member’s Case Manager or Waiver Service Coordinator and be authorized by Waiver Utilization Management prior to delivery of service.
  • The provider will receive a separate authorization for ADS transportation.

Assisted Living Memory Care

On January 2, 2024 changes were made to the tier structure in Assisted Living Waiver billing, including the addition for Assisted Living Facilities to become "certified" for memory care.

Prior billing included 3 level Tiers for rate reimbursement based upon the members needed care. Tier 1 (also U1) was the least amount of needed care and the lowest reimbursement. Level 2 (U2) and Level 3 (U3) could be used for higher care levels for members.

With the new changes that occurred January 2, 2024, there are now only 2 levels of care for billing/reimbursement. Tier 1 (U1) and Tier 3 (U3).

Tier 3 can only be used for Assisted Living facilities that have applied for Memory Care through ODA and have been approved. This certification is also to be listed on the facilities website.

Facilities which are approved for certified Memory Care through ODA, by meeting the requirements in the OAC, https://codes.ohio.gov/ohio-administrative-code/rule-173-39-02.16 , have the option to bill U1 or U3.

The additional requirement to be able to bill U3, requires the member to have a dementia diagnosis (or diagnosis under the dementia umbrella). The dementia diagnosis should be listed on the claim when facilities are billing under a U3.

Facilities that have not gone through certification and approval through ODA, are only able to bill U1. Tier 2 (U2) is no longer an option.

If you need additional information on submitting claims or reason for claims denial, Buckeye's Provider Services can be reached at 866-296-8731.

 

EVV

Electronic Visit Verification

July 1 Electronic Visit Verification program changes

The Ohio Department of Medicaid (ODM) is making policy updates and system enhancements to the Electronic Visit Verification (EVV) program. These changes go into effect July 1, and include: 

  • Ohio Medicaid EVV proposed rule updates.
  • System enhancements to Sandata devices and applications.

Requirements for the current EVV program are detailed in Ohio Administrative Code (OAC) rule 5160-1-40. Ohio Medicaid is proposing to separate this comprehensive rule into four focused rules: 

  • OAC 5160-32-01 EVV program
  • OAC 5160-32-02 EVV data collection
  • OAC 5160-32-03 Alternate EVV vendor
  • OAC 5160-32-04 EVV program provider requirements

To stay updated on OAC rule activity, please create an account here. To view previous, current, and proposed OAC rule update activity, visit the Register of Ohio website here.

Materials and educational opportunities will continue to be communicated as the program prepares for changes occurring July 1. To stay updated on ODM EVV program communications you can sign up for notifications by clicking on the ODM website.

In case you missed them - 2024 presentations!

Beginning in January 2024, ODM and Sandata began sharing important information for stakeholders. The webinars provide overviews of proposed enhancements to systems and updates to the program. Stakeholders can access this information through the EVV website and with the links below:

EVV Webinars

1.January 2024 Electronic Visit Verification Program

2.April 2024 Proposed Policy Updates and System Enhancements

Ask a trainer

Do you have questions about EVV?

Do you have questions about EVV? You can schedule a session by clicking EVV Help to reserve a private Zoom call with a Sandata trainer. During the session training materials and resources will be shared and all your EVV questions can be addressed. Sessions are available Monday-Friday at 11:30 a.m. and 3:30 p.m., Eastern time. If these times do not work for your schedule, please reach out to odmevvtraining@sandata.com to request an alternate time.

The following topics are addressed in the sessions:

  • Getting started with EVV.
  • Improving EVV claims matchi
  • Solving reoccurring exceptions.

There is no limit to the number of sessions you can attend. If you schedule a session and need to cancel, please do so in advance using the instructions on the confirmation email.