CareSource, the largest managed care organization of Medicaid in Ohio, has confirmed it will claw back 15% of reimbursements made to some behavioral health providers over the past two years. The decision stems from historically paying the full amount to providers who were only meant to be reimbursed 85%.
Reimbursement Discrepancy
Under the Ohio Administrative Code, behavioral healthcare providers accredited by the Ohio Department of Mental Health and Addiction Services (OMHAS) as official Community Behavioral Health Centers receive 100% reimbursements. These are known as Medicaid Provider Types 84 and 95. Those without that accreditation are to be reimbursed 85% instead. CareSource discovered the error during a routine claims review. The agreement between CareSource and the Ohio Department of Medicaid allows managed care organizations to recoup overpayments within two years.
Provider Impact and Response
CareSource stated it will work with providers to review individual circumstances and is committed to protecting members’ access to quality care and supporting provider network stability. However, some mental health professionals have sounded the alarm that the clawbacks could lead providers to close or drop CareSource, jeopardizing essential care for Medicaid patients. Mary Hall, president of MGH Healthcare in Howland, said she understood CareSource would work with providers to pay back the money over time while keeping practices going.
Forward Process
Going forward, reimbursement rates will be corrected to 85%. CareSource characterized this as an effort to ensure accurate claims payment in accordance with their fiduciary duty as a steward of public funds. The Ohio Council of Behavioral Health & Family Services Providers stated it will continue to monitor the issue closely and provide updates and guidance to members.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.wfmj.com/news/ohio-pennsylvania-news/caresource-clawing-back-overpayments-to-some-behavioral-health-providers/article_7c8e284a-db65-4208-b5e7-e8dd5265be2b.html