Medicaid Managed Care Plans (MCPs) may cover IMD services effective 7/1/2017
Starting July 1, 2017, Ohio implemented 42 C.F.R. 438.6 in the federal managed care regulations to allow for Medicaid recipients age 21 through 64, who receive their Medicaid benefits through a MCP, to receive inpatient treatment in an Institution for Mental Disease (IMD). This includes MyCare Ohio Plans since they are MCPs.
How will this impact individuals covered by both Medicare and Medicaid?
Medicaid is always the payer of last resort. When a member with Medicare coverage exhausts their lifetime Medicare allowance for inpatient psychiatric hospital stays, Medicaid MCP will provide coverage under this policy regardless of the member's age.
The policy will implement 42 C.F.R. 438.6 in the federal managed care regulations that expands the Medicaid-reimbursable inpatient psychiatric provider network to give Medicaid MCP members access to more timely, medically appropriate, and cost-effective services by allowing IMDs to be used in addition to other covered settings, such as inpatient psychiatric units in general medical hospitals.
Note: OhioMHAS-operated state hospitals will continue to serve as a safety net network and will operate as an out-of-network provider network for managed care plans.
Role of Aetna
Aetna Better Health of Ohio will work with our members and provider networks on assessing an individual's need for care to determine both the level of care and the appropriate care setting. Aetna will coordinate with the admitting facility to ensure proper care and transition of members back into the community, which may include coordinating with community mental health services and providers.
Role of Local Crisis Providers Who Handle the Coordination of Psychiatric Hospital Admissions
Crisis providers will continue to function as they do today, but will need to work with Aetna for coordinating admission to IMD facilities when necessary. Aetna will work closely with providers for coordinating care and services for members. More information is available on our website at www.aetnabetterhealth.com/ohio/providers.
State of Ohio Resources
Aetna Better Health of Ohio Contact Information
- Provider Services 1-855-364-0974, option 2