Shift to an Agency-Only Model: Independent Provider Changes

In Governor John Kasich’s Executive Budget, the State of Ohio is proposing shifting to an agency-only model to improve oversight, fight fraud and abuse, and improve health outcomes for individuals. If approved, this change would phase out independent providers, unless they are providing services under a self-directed waiver.

Below is updated information about who may be impacted by this change, options for those who are affected, and the time line.

Who is affected?

  • ​Individuals working with agency providers are not affected.
  • Individuals on a self-directed waiver are not affected. Currently, one of DODD’s waivers is a self-directed waiver – the Self-Empowered Life Funding (SELF) Waiver.
  • Individuals on the Independent Options (IO) and Level 1 waivers will be affected. However, DODD will add a self-directed option to these waivers, which will allow you to continue working with non-agency providers through Employer Authority.​
  • Agency providers are not affected.
  • Independent providers who provide services under a self-directed waiver are not affected. Currently, one of DODD’s waivers is a self-directed waiver – the SELF waiver.
  • Independent providers who provide services under the Independent Options (IO) and Level 1 waivers will be affected. However, DODD will add a self-directed option to these waivers, which will allow non-agency providers to serve individuals through Employer Authority.
  • Note: DODD isn’t adding a self-directed option to the Transitions DD waiver because that waiver is being phased out.

What are my options?

  • Independent providers can seek employment through an agency provider if that option works for you.
  • Independent providers can provide services under a self-directed waiver.
  • Individuals working with independent providers can select an agency provider, or continue working with their non-agency provider under Employer Authority.

What are the key dates?

This change would take place over a three-year period to allow individuals and providers to make any transitions. Key dates include:

  • July 1, 2016: The Ohio Department of Medicaid (ODM) will not enroll any new independent providers.
  • July 1, 2016-June 30, 2019: Current independent providers will not have their certification renewed when it expires – they can continue providing services until their certification expires.
  • July 1, 2019: ODM no longer will accept claims with dates of service after July 1, 2019, submitted through independent providers, except in cases of self-directed waiver services.

See a helpful chart, ‘What These Changes Mean for Me,’  for more information.

Watch for updates in Pipeline, and on DODD.Ohio.gov. If you have questions, please call the DODD Budget and Developmental Center Closure Hotline toll-free at 855-611-6446 (OHIO) or 614-728-5311.

Advertisements