MedicaidAdministrativeHigh impact
[Ohio] Missed Home and Community Based Services (HCBS) visit requirements
Anthem BCBS·OH · Occupational Therapy, Physical Therapy, Speech Therapy +2 more·Provider Bulletin
Effective date
Apr 3, 2026
We identified it
May 3, 2026
Summary
Anthem's Ohio MyCare plan now requires HCBS providers to report all missed, delayed, or cancelled home and community-based services visits with specific timelines: same-day reporting for safety-related missed visits, and 24-hour reporting for all other missed visits. Providers must activate back-up plans, verify member safety, notify appropriate coordinators, and document all incidents per Person-Centered Services Plan requirements.
Action Required
By April 3, 2026 (or immediately if not yet implemented): Billing and administrative teams must establish missed visit reporting procedures: (1) Create a tracking system to identify and log all missed, delayed, or cancelled HCBS visits; (2) Implement same-day reporting protocols for visits affecting member health/safety to appropriate coordinator (Area Agency on Aging for members 60+, or Anthem at MyCareHCBS_MissedServices@anthem.com for members under 60); (3) Establish 24-hour reporting process for all other missed visits; (4) Update encounter documentation templates to capture: scheduled date/time, reason for miss, member contact attempts, actions taken, and notification details; (5) Train clinical and administrative staff on back-up plan activation requirements and member verification procedures; (6) Establish internal escalation process for safety-related incidents requiring same-day reporting. Failure to report missed visits per timelines may result in compliance violations and potential sanctions from Anthem and state regulators.