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Nursing-home groups urge statutory fix to avoid PDPM-driven cuts in Medicaid reimbursement
Summary
LeadingAge Ohio told the Senate Finance Committee a technical omission in HB 96 could produce large, unintended cuts to nursing facility reimbursements as the state moves from RUGS to PDPM case-mix scoring unless the legislature adopts a conversion factor amendment.
Susan Wallace, testifying for LeadingAge Ohio, told the Senate Finance Committee the department’s transition from the RUGS case-mix system to PDPM could produce an “immediate, effective cut” to nursing facility reimbursements unless the legislature adopts a statutory conversion factor. Wallace said the change is not a change in services but a change in measurement: under RUGS the average statewide case mix score was roughly 3.0, whereas PDPM-based nursing scores average about 1.4. Without a conversion multiplier the move would reduce facility payments; LeadingAge proposed a factor that would bring PDPM scores to parity with historical funding levels and identified amendment number SC 2858 for a technical fix.
Wallace and other witnesses told senators the Department of Medicaid may lack administrative flexibility to fix the error by rule because Ohio law contains detailed statutory reimbursement provisions for nursing facilities. Wallace described the impact as “about $70 on average, across the state, to nursing homes” per some unit of measure and said the omission could amount to “hundreds of millions of dollars.” She said the association favored immediate statutory correction, though the department proposed a phased transition. Wallace said she and providers had also sought “stop loss/stop gain” protections and a blended rate that would include nursing, speech-language pathology and non-therapy ancillary components, but those items were not included in the current budget proposals.
Why it matters: Nursing-facility reimbursement supports long-term care providers statewide; a statutory omission tied to measurement conversion can change provider payments without an explicit policy decision unless corrected. Committee members asked whether the Department of Medicaid could resolve the issue by administrative rule; witnesses said the statutory detail governing facility reimbursement likely prevents a rule-based fix and urged a legislative correction.
Ending: LeadingAge Ohio requested the committee include the technical amendment (SC 2858) in the omnibus amendment to HB 96 to preserve funding parity during the transition to PDPM.
