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Ohio hospices urge lawmakers to fix 95% room-and-board reimbursement and pause EVV denials
Summary
Hospice providers told the Senate Medicaid Committee that current Medicaid rules paying hospices 95% of nursing-facility room-and-board rates force hospices to absorb costs, and they urged lawmakers to require parity and to delink electronic visit verification from immediate claims denials while the vendor's system is unreliable.
Hospice and home-care providers pressed the Ohio Senate Medicaid Committee on May 8 to fix two separate but related problems they say threaten access to end-of-life and home-based care: a long-standing 95% hospice pass-through for nursing-facility room and board, and ongoing failures in the state's electronic-visit-verification (EVV) system.
"Valley Hospice paid the full 100% to nursing facilities while Medicaid reimbursed only 95%," said Andrea Hale, chief executive officer of Valley Hospice. "For us, that amounted to over $180,000 in unreimbursed costs last year alone." The policy dates from early Medicare-era rules, witnesses said, and does not reflect the reality that many hospice patients now reside in nursing facilities.
Lisa Von Lemden, executive director of the Ohio Council for Home Care and Hospice, told senators the underpayment discourages skilled nursing–based hospice care and forces nonprofits to cut patient services or staff. She asked the committee to require the Department of Medicaid and Department of Aging to adopt rules ensuring hospices receive 100% of facility room-and-board rates for eligible hospice patients.
Providers also urged a halt to automatic claim denials tied to EVV readings. Von Lemden and agency leaders said Ohio's EVV vendor has had frequent downtime, poor support and configuration mismatches that produce failed verifications even when services were delivered. "Until the EVV system works reliably, it is both unfair and administratively irresponsible to punish providers by withholding payment for services that were delivered in good faith," she told the committee.
Provider witnesses said denials tied to EVV edits have averaged about 16% — a large share given the thin margins many Medicaid home-care agencies operate under. "In a world where we have about a 3% profit margin under Medicaid services, it's actually causing an effect where we are starting to see now agencies that are leaving Ohio Medicaid," Von Lemden said.
Witnesses proposed several legislative fixes: a statutory pass-through to reimburse hospices at 100% for facility room and board, a moratorium on adjudicating claims by EVV compliance until the system is fixed, a standardized annual rate review tied to costs and inflation and expanded support for self-direction.
Senators asked clarifying questions about the timing of EVV denials and technical fixes; providers said the department has been meeting with stakeholders but the system's persistent problems still leave many providers at risk. The committee did not take immediate action on the requests.
