The Ohio Department of Jobs and Family Services revised the Medicaid rules and the new rules went into effect on February 16, 2009.
Of note in the new rules:
Elimination of the prohibition against PAs billing for seeing new patients, seeing existing patients with a new condition, or admitting and discharging patients to a hospital without a physician also seeing the patient. (Note: This is a correct statement of the change in the reimbursement rule. However, under Ohio law the actual admission to the hospital must still be done by a physician, dentist, or podiatrist, not a PA. The reimbursement rule does not affect this requirement.)
Reimbursement for approved services will be at the lesser of the provider's billed charge or eighty-five percent of the Medicaid maximum
Reimbursements for PA services are not payable to the PA directly, but can only be paid to the physician, physician group practice, or clinic employing or contracting with the PA.
The new rule excludes the following services from PA reimbursement:
The employing physician, physician group practice, or clinic may be directly reimbursed for PA services performed in a nursing facility or an intermediate care facility for the mentally retarded.
The new rules clarify that there is no separate reimbursement for services provided to a hospital-employed PA. The reimbursement for such services is bundled into the facility payment made to the hospital.