The Ohio Department of Medicaid (ODM) has released a Request for Applications (RFA) inviting managed care organizations (MCO) to submit proposals for Ohio’s next generation managed care program supporting more than 90 percent of Ohioans receiving health care services through Medicaid.

The RFA represents a major step toward advancing the state’s Medicaid program.

It is an evolutionary upgrade – the first structural change since the Center for Medicare and Medicaid Service’s (CMS) approval of Ohio’s program in 2005.

ODM’s 21st-century managed care program will prioritize the individual as the focus of care, optimize real-time health data with advanced, personalized care methods and value-added incentives that go beyond the status quo to deliver Ohio the best value in quality health care.

The RFA was developed following an 18-month campaign that garnered nearly 1,100 pieces of feedback from providers, members, advocates, health care and government leaders, including listening sessions across Ohio. In response, today’s RFA describes cost conscious, innovative provisions that reflect stakeholder insights and align MCO requirements to ODM’s five visionary goals for the future:

• Improve wellness and health outcomes.
• Emphasize a personalized care experience.
• Support providers in better patient care.
• Improve care for children and adults with complex needs.
• Increase program transparency and accountability.

“We envision a managed care program in which ODM and the MCOs work together to tackle some of the toughest health challenges and disparities,” said Maureen Corcoran, director of ODM.

“We can achieve health care excellence by introducing a seamless service delivery system that works for members, providers, and community partners. Bidders will be assessed based on their ability and interest in partnering with ODM to achieve the goals of the future program.”

The solicitation includes a series of qualitative questions requiring respondents to provide examples of how they would address current issues related to the Medicaid managed care program including providing person-centered care, serving children with complex needs, developing and executing a population health strategy, and simplifying / streamlining administrative processes.

ODM’s managed care procurement is central to a comprehensive procurement strategy that introduces specialized components to deliver greater transparency and accountability in managing its pharmacy benefits, eliminate provider administrative redundancies in the credentialing and enrollment process, simplify claims submissions and management via a fiscal intermediary, and provide high-intensity wrap-around services and supports for Ohio’s children and adolescents with complex behavioral health needs. Unbundling certain responsibilities from the current managed care design allows specialization and focus on areas of critical need and facilitates unprecedented transparency in the administration and delivery of services.

The request for application will be posted until November 20, 2020. Bidders can learn more about the managed care procurement process and goals by visiting https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/.