Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Medicaid Reimbursement topic
No spam. Unsubscribe anytime.
LeadingAge Ohio urges technical fix to nursing facility reimbursement change in HB 96
Summary
LeadingAge Ohio told the Senate Finance Committee a conversion to PDPM scoring in Medicaid without a statutory adjustment would produce an ‘‘immediate, effective cut’’ to nursing facility reimbursements and urged the committee to include a technical fix and other transition protections in the omnibus amendment.
Susan Wallace, speaking for LeadingAge Ohio, told the Senate Finance Committee that proposed changes in the state budget related to the transition from RUGS to the PDPM assessment system could cause wide swings in nursing facility reimbursement unless the General Assembly adopts a statutory technical fix.
"It would be about $70 on average, across the state, to nursing homes," Wallace said, describing the conversion mismatch in scores and urging the committee to adopt amendment language to translate historical case-mix measures into the new PDPM metric.
Wallace told senators that the PDPM shift is not optional — it follows federal changes that Ohio has tracked since 2019 — but warned the committee the Department of Medicaid is constrained by the Ohio Revised Code in how it implements reimbursement changes. "The Department of Medicaid must follow that language to the T," she said, arguing the Legislature should act to prevent an unintended de facto cut for providers.
LeadingAge Ohio described recommended policy changes including a conversion multiplier to raise the PDPM statewide average (testimony cited current statewide RUGS average ~3 versus PDPM average ~1.4) and said it had proposed stop-loss/stop-gain protections to soften transitions. Wallace provided amendment numbers on the record for committee consideration, and said the organization prefers an immediate statutory correction rather than an administrative rule change.
Why it matters: Witnesses framed the issue as a technical but budget-significant change in how nursing intensity is measured and reimbursed under Medicaid. LeadingAge Ohio estimated that the omission could translate into “hundreds of millions of dollars” statewide and urged statutory clarity to avoid providers absorbing cuts.
Committee exchange: Senators asked about timing, the proposed multiplier, and whether the Department of Medicaid could address conversion via rule; Wallace and others said statute currently prescribes detailed nursing facility reimbursement formulas and that clarity in the budget language is the safest path. Wallace said her group’s amendment is numbered 2,858 and that PACE-related amendments include 2,619 and 02/1955.
Ending: The witness urged the committee to include the technical fix in the omnibus amendment; the committee did not record a vote on the proposal during the hearing.
