ODMR 2425-0008 Next Generation MyCare Ohio Plans Request for Application

To help shape the design of its Next Generation MyCare Ohio program, ODM began seeking input from stakeholders in September of 2022. ODM solicited program feedback and improvement recommendations from an array of stakeholders that included individuals enrolled in MyCare and their families; advocates for individuals enrolled in MyCare; managed care plans, MCOPs, and dual-eligible special needs plans; providers; provider associations; partner state agencies; and other persons and organizations. The input from stakeholders informed ODM’s development of the Next Generation MyCare Ohio program, which is reflected in this RFA.  ODM intends to contract with MCOPs that will be responsible for the benefits covered under the current MyCare Ohio duals demonstration program. For the Next Generation MyCare Ohio program, ODM will require the MCOPs to be CMS approved fully integrated dual eligible special needs plans (FIDE SNPs) to maximize service coordination and integration and create a more seamless user experience for members.   To be eligible for the Next Generation MyCare Ohio program, an individual must be a dual eligible recipient, be age 21 or older, and reside in the state of Ohio. Dual eligible recipients will continue to be required to enroll in an MCOP for their Medicaid benefits but may choose whether to receive their Medicare services from the MCOP or another payer. An individual’s decision to enroll in the MCOP for Medicare benefits will result in the individual’s enrollment in the MCOP for both Medicare and Medicaid benefits. Individuals enrolled in a managed care organization (MCO) with an affiliated MCOP who become eligible for the Next Generation MyCare Ohio program and do not choose to receive their Medicare benefits through another Medicare payer will be deemed to have elected the MCOP for both their Medicare and Medicaid benefits.     The Next Generation MyCare Ohio program will operate in accordance with the Model Next Generation MyCare Ohio Provider Agreement, Attachment A of this RFA, including the Model Agreement between ODM and Contractor, Attachment 1 of Attachment A of this RFA (the State Medicaid Agency Contract [SMAC]).   ODM has designed the Next Generation MyCare Ohio program to achieve the following goals:  Focus on the individual; 
Improve individual and population wellness and health outcomes;  Create a personalized care experience;  Support providers in continuously improving care; 
Improve care for individuals with complex needs to promote independence in the community; and 
Increase program transparency and accountability.  
Ohio’s Next Generation MyCare Ohio program will advance many of these goals through ODM’s population health approach, which is designed to address health inequities and disparities and achieve optimal outcomes for the holistic well-being of individuals enrolled in MyCare Ohio.   ODM envisions its MyCare Ohio program to be one in which ODM and the MCOPs coordinate and collaborate to achieve health care excellence by integrating the coordination, provision, and payment of Medicare and Medicaid funded services for dual eligible individuals, providers, and system partners.  To reduce provider burden and promote consistency across the MyCare Ohio program, ODM will centralize claims submission, prior authorization submission, and credentialing and re-credentialing. ODM’s fiscal intermediary will serve as a single clearinghouse for all medical (non-pharmacy) claims. ODM’s fiscal intermediary will also serve as the single, centralized location for provider submission of prior authorization requests. Under ODM’s centralized credentialing process, providers will submit an application for Medicaid enrollment and credentialing to ODM and will not need to submit Medicaid credentialing and recredentialing materials to MCOPs.