State changing health coding systems, providers say they’re not ready


COLUMBUS (WCMH) — Starting in July, Ohio is set to change the way mental health and addiction services are regulated and billed, but some providers say they are not ready and services will suffer. It’s called the Behavior Health Redesign, it’s a plan by the Ohio Department of Medicaid to bring Ohio’s systems up to national standards with the goal of expanding treatment services and access.

The Ohio House of Representatives added a six-month delay in the current state budget for the redesign date, and many are testifying before the Senate Finance Committee this week to advise them to continue to delay.

“They are not ready to go live,” Teresa Heim said, the owner of Behavioral Health Billing Solutions in Ohio. Heim testified before the Senate Finance Committee Wednesday, asking for a six-month delay saying providers are not ready for the redesign, and patient care will suffer.

“Almost immediately you are going to see a very small list of behavioral health agencies able to bill,”  Heim said.

She is not alone in her quest.

“It’s a complex change and it requires a lot of time” said Lori Criss with the Ohio Council of Behavioral Health and Family Services Providers. The advocacy group represents more than 150 health providers in Ohio, many of which are non-profits.

Criss worries what will happen to addiction and mental health patients, “If the redesign goes live July 1, we will see a significant drop in access and capacity for mental health and addiction services,” Criss said.

According to Criss, the Department of Medicaid must get the rules and regulations in order and the health providers must get their IT and software programs up to speed. “If the state is not ready then the behavior health providers can’t be ready,” Criss added.

The Ohio Department of Medicaid has been working on the redesign for nearly three years. Director Barbara Sears gave the following statement to NBC4:

“While we understand change can be difficult to some, providers have access to a test environment to ensure that their systems are ready go live on July 1st, which is supported by a call center run by Medicaid staff to answer questions. Moving forward with the July 1st date is not only the right thing to do for consumers, but also for the majority of providers who are ready to help those individuals with their behavioral health needs.”

The House version of the budget now includes a January 1st, 2018 start date for the redesign, but it will be up to the Senate to keep it or not. The budget must be finalized by the end of the month.

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