This State Plan Amendment (SPA) looks to provide Medicaid coverage for eligible members to receive general pediatric vaccine counseling as part of EPSDT. Beginning with dates of service on or after September 1, 2022, stand-alone general pediatric vaccination counseling as part of the early and periodic screening, diagnostic, and treatment (EPSDT) benefit will be reimbursed under CPT 99401 with modifier EP per the fee schedule.

Adds prospective payments and gainsharing to the physician services Alternative Payment Model (APM) for non-Federally Qualified Health Center primary care medical providers.

Updates the state plan DRG rates.

Updates the state plan Nursing Facility (NF) rates.

Updates the rates for certain EPSDT services. including physician services and autism spectrum disorder services.

Allows the Division of Medicaid (DOM) to update rates for MAT services according to the applicable fee schedule and reimburse for Opioid Treatment Programs (OTPs) based on ninety percent (90%} of the Medicare fee schedule updated each July, effective for services provided on or after that date.

Allows the Division of Medicaid (DOM) to update the Physician Fee Schedule July 1 of each year based on ninety percent (90%) of the Medicare Physician Fee schedule in effect January 1, 2022 and as may be adjusted each July thereafter.

Allows reimbursement rates for other licensed practitioners to be updated, when applicable, according to the appropriate State Plan payment methodology.

Allows the Division of Medicaid (DOM) to reimburse independent laboratory and X-Ray services from a statewide uniform fee schedule based on ninety percent (90%) of the Medicare fee schedule updated each July and effective for services provided on or after that date,

This amendment proposes to establish coverage and payment for mobile response and stabilization services and updates the payment rates for child and adolescent needs and strengths as part of the OhioRISE program.