House Bill 795, also known as the “SHIELD” Act, originally sought to crack down on “fraud, waste and abuse” in the Medicaid system by implementing stricter requirements for electronic home-visit verifications. Due to “investigative reporting” by the Daily Wire on widespread and rampant fraud in Ohio’s Medicaid system, legislators have decided to broaden the scope of the bill.

The bill, as amended, would require the Department of Medicaid to require all therapeutic behavioral services to undergo prior authorization. What that means for you is that any services provided to a client who is enrolled in Medicaid will need to be pre-approved by their managed care organization.

National narratives about Medicaid fraud are heavily influencing this legislative process. As a result, the situation remains very fluid and open to change, especially if lawmakers hear from their constituents that this bill will be detrimental to them. However, the conversation is trending toward a more restrictive, harder-to-bill, and barrier-laden Medicaid program.

The bill still has several hurdles to cross before it becomes law, so there is still time for you to change the conversation. We anticipate that the bill will be voted favorably out of the Ohio House Medicaid Committee this week, positioning it for passage into law next week.

Reach out to the legislators that represent you and the Medicaid Committees (House & Senate) and voice your opinion about the impact of having to receive prior authorization on every claim for clients with Medicaid.