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.