Health

The National Law Review

partner publisher · 20.0K followers

Client Alert: Proposed Changes to Behavioral Health Service Rules: Key Changes for Ohio Providers to Review

The Ohio Department of Behavioral Health (DBH) recently proposed numerous changes to Ohio Administrative Code (OAC) Chapter 5122-29, which governs the behavioral health services that DBH-certified providers may provide. The proposed rule changes would rescind and replace several existing rules, amend others, and create a new service category and rule for adult crisis services. The existing rules summarized below (OAC 5122-29-03 through 5122-29-29) are currently under Common Sense Initiative (CSI) review and may be subject to additional changes. The new adult crisis services rule (OAC 5122-29-32) is scheduled for a public hearing on November 16, 2026. The table below does not provide a comprehensive summary of every proposed rule change in OAC Chapter 5122-29. Proposed rules that only had stylistic changes, not substantive changes, were not summarized. Additionally, proposed rules for certain certified services, including forensic evaluation, driver intervention programs, intensive home-based treatment, among others, were not summarized for purposes of this Client Alert. A summary of the proposed rules is below. Rule Number Tagline Type of Filing Summary of Content and Proposed Changes OAC 5122-29-03 General services Rescind in full and replace with new rule • Defines “general services” as assessment, medical, and counseling and therapy activities. • Requires

Ohio · 15d

The National Law Review

partner publisher · 20.0K followers

Ohio Department of Medicaid Proposes New Provider Suspension Rules as Centers for Medicare & Medicaid Services Escalates Its Anti-Fraud Push

Amidst heightened federal scrutiny of Medicaid fraud, waste, and abuse, the Ohio Department of Medicaid (ODM) recently proposed two new rules governing the suspension of Medicaid provider agreements and the suspension of claims payments. Ohio Administrative Code (OAC) 5160-1-17.5 replaces the current suspension rule, and OAC 5160-1-17.51 replaces the emergency rule ODM adopted on June 2, 2026. Federal Context: Centers for Medicare & Medicaid Services (CMS) Targets a Sharp Rise in Suspensions Federal regulators have made provider fraud a top enforcement priority, deploying new authorities, technologies, and coordination tools designed to stop improper payments before they are made. CMS seeks to quadruple provider suspensions within six months as part of CMS' overall crackdown on fraud. To that end, CMS has undertaken several measures that suggest providers face growing exposure: New exclusion authority . The Department of Health and Human Services (HHS) delegated permissive exclusion authority under Section 1128(b) of the Social Security Act to CMS, effective October 14, 2026. CMS may now exclude providers from Medicare, Medicaid, TRICARE, and other federal health care programs when a basis for exclusion exists, such as a provider's violation of the False Claims Act. Artificial Intelligence (AI)-driven, pre-payment detection . CMS is piloting AI

Ohio · 15d