Ohio Medicaid Implementing ‘Payer Of Last Resort’ Rules For Behavioral Health

Ohio Medicaid will implement an enhanced “payer of last resort” policy for behavioral health services starting July 1, 2017. The implementation is part of the state’s Medicaid behavioral health redesign. It requires Medicaid behavioral health provider organizations to participate in Medicare so that when they serve beneficiaries dually eligible for Medicare, the provider organization must submit the bill to Medicare first. The policy also applies to the services provided to the few Medicaid beneficiaries with commercial health coverage or other coverage.

Under the expanded policy, a Medicaid provider organization that delivers a Medicare-billable service provided by a Medicare . . .