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LeadingAge Ohio urges technical fix to nursing facility reimbursement amid PDPM transition
Summary
Representatives from LeadingAge Ohio told the Senate Finance Committee a statutory technical omission related to the transition from RUGS to PDPM could produce de facto cuts to nursing facility payments and asked for an omnibus amendment (No. 2,858) to direct a conversion factor and prevent unintended reductions.
Susan Wallace, testifying for LeadingAge Ohio, told the Senate Finance Committee that a technical omission in Ohio law tied to the federal transition to the Patient Driven Payment Model (PDPM) could create substantial, unintended reimbursement cuts for nursing facilities.
"It would be about $70 on average, across the state, to nursing homes," Susan Wallace said, describing a translation problem moving from one case-mix measurement system to another and arguing the omission could translate into a sizable statewide change in rates.
LeadingAge Ohio asked the committee to include a technical amendment (amendment number 2,858) in the omnibus bill that would allow the Department of Medicaid to develop a conversion factor to align PDPM case-mix scores with the legacy RUGS scoring used in statute. Wallace said the group also supported, but was not pressing at this hearing, proposals for a blended rate and stop-loss/stop-gain protections that had not been included in either the House or Senate versions.
Committee members pressed why the change could not be made administratively. Wallace replied that nursing facility reimbursement details are spelled out in the Ohio Revised Code and that the Department of Medicaid may lack statutory flexibility to apply an administrative fix without legislative language. Wallace and other witnesses told senators that the change could affect providers unevenly, with some losing hundreds of thousands and others gaining, and recommended immediate statutory correction to prevent an "immediate, effective cut."
Ending: LeadingAge Ohio provided amendment numbers for PDPM and PACE proposals (PDPM technical fix SC 2,858; PACE amendments SC 2,619 and SC 2,655) and offered to continue working with legislators on rate-setting and conversion metrics.
