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Nursing homes urge technical fix to PDPM transition, warn of immediate reimbursement cuts
Summary
LeadingAge Ohio and provider groups testified that a statutory technical fix is needed in HB 96 to prevent unintended nursing facility payment reductions as Ohio moves from RUGS to PDPM; witnesses urged immediate legislative action and proposed conversion multipliers and stop‑loss measures.
Representatives of LeadingAge Ohio and allied provider groups told the Senate Finance Committee that the state’s transition from the RUGS reimbursement system to the CMS PDPM model risks producing an effective cut to nursing facility payments unless the General Assembly adopts technical statutory language in the budget.
Susan Wallace of LeadingAge Ohio described the proposal as a “technical fix” the Department of Medicaid cannot implement administratively because longstanding nursing facility reimbursement details are codified in the Ohio Revised Code. “The Department of Medicaid must follow that language to the T,” Wallace told the committee, and without corrective language the move to PDPM would produce an unintentional average reduction of “about $70” per facility across the state and much larger swings for individual providers.
The nut graf: witnesses asked the committee to adopt an amendment (testimony referenced as amendment numbers) that would create a conversion factor to translate PDPM case‑mix scores into the previous funding scale and protect providers with stop‑loss/stop‑gain mechanisms during the transition.
Wallace and other witnesses described mechanics: under RUGS the statewide average case mix score is about 3.0; under PDPM the comparable statewide score for the nursing component is about 1.4. Providers proposed creating a conversion multiplier (testimony referenced “about 2.1–2.2”) and asked the Department of Medicaid to be authorized statutorily to set that factor based on its data. The witness said that absent a statutory fix the change could represent “hundreds of millions of dollars” and that the department may lack rulemaking authority to implement the conversion without new language.
Senators asked whether the change could be made by rule; witnesses replied they believed statute was necessary because Ohio’s nursing facility reimbursement is described in detail in the Revised Code. Wallace said providers had previously requested a phased transition and stop‑loss protections but those elements were not included in the House or Senate versions under consideration.
Ending: witnesses urged immediate inclusion of the technical amendment in the omnibus budget to prevent an abrupt funding shift at the start of the PDPM era; no formal committee vote on an amendment was recorded in the hearing.
