Common use of Prescribing Clause in Contracts

Prescribing. There was a provision in MCDCD49 allowing an Advanced Practice Registered Nurse (APRN) who is certified in psychiatric mental health by a national certifying organization to prescribe atypical antipsychotics and antidepressant drugs without going through prior authorization. This provision already exists for psychiatrists. Given the existing high rate of prescribing for “preferred” agents, we do not anticipate a material shift in volume to more expensive agents. ◾ Comprehensive Primary Care (CPC). A portion of the MMC population is enrolled in the Ohio CPC program, and the MCPs may be required to pay gain sharing payments to participating providers. To receive a gain sharing payment, a provider would need to achieve a cost of care level lower than historical levels. For this reason, no adjustment is applied in the CY 2019 rate setting process for CPC, as gain sharing payments are assumed to be offset by the cost of care savings achieved by the CPC providers. ◾ Dental Program Changes. Effective July 1, 2018, Silver Diamine Fluoride (SDF) was included as a covered dental benefit in the MMC program for all ages. In addition, effective January 1, 2018, coverage for tobacco cessation and counseling services are a covered dental benefit. Based on information provided by ODM, we estimated coverage of SDF and tobacco cessation to be budget neutral.

Prescribing. There was a provision in MCDCD49 allowing an Advanced Practice Registered Nurse (APRN) who is certified in psychiatric mental health by a national certifying organization to prescribe atypical antipsychotics and antidepressant drugs without going through prior authorization. This provision already exists for psychiatrists. Given the existing high rate of prescribing for “preferred” agents, we do not anticipate a material shift in volume to more expensive agents. ◾  Comprehensive Primary Care (CPC). A portion of the MMC population is enrolled in the Ohio CPC program, and the MCPs may be required to pay gain sharing payments to participating providers. To receive a gain sharing payment, a provider would need to achieve a cost of care level lower than historical levels. For this reason, no adjustment is applied in the CY 2019 rate setting process for CPC, as gain sharing payments are assumed to be offset by the cost of care savings achieved by the CPC providers. ◾  Dental Program Changes. Effective July 1, 2018, Silver Diamine Fluoride (SDF) was included as a covered dental benefit in the MMC program for all ages. In addition, effective January 1, 2018, coverage for tobacco cessation and counseling services are a covered dental benefit. Based on information provided by ODM, we estimated coverage of SDF and tobacco cessation to be budget neutral.