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Nursing facility groups urge statutory fix to prevent unintended cuts from PDPM switch
Summary
Susan Wallace of LeadingAge Ohio told senators that a technical omission in the Medicaid reimbursement language could produce an unintended, immediate cut for nursing facilities as Ohio moves its case‑mix system from RUGS to PDPM.
Susan Wallace of LeadingAge Ohio told senators that a technical omission in the Medicaid reimbursement language could produce an unintended, immediate cut for nursing facilities as Ohio moves its case-mix system from RUGS to PDPM. "It would be about $70 on average, across the state, to nursing homes," Wallace said, adding the shift without a conversion factor would create wide swings for individual providers.
Nut graf: Witnesses from provider groups said PDPM—a federal case‑mix model adopted by CMS—changes how nursing intensity is measured. Because Ohio’s nursing facility reimbursements are specified in detail in the Ohio Revised Code, LeadingAge Ohio argued the change requires legislative language to translate old scores to the new PDPM scores and preserve budget neutrality during the transition.
Wallace described a proposed amendment (SC 2858) that would let the Department of Medicaid develop a conversion multiplier and said provider analysis suggests a multiplier "about 2 point something" is needed to equalize prior case-mix levels. She urged immediate statutory action, arguing the department may lack lawful flexibility to implement a conversion by rule. Committee members asked about stop‑loss mechanisms and phased transitions; Wallace said the Department of Medicaid had proposed a phased approach but industry groups had sought additional mitigation that did not make it into the House or Senate versions.
The witnesses also asked for protections to avoid arbitrary reimbursement reductions, and for the omnibus amendment to include specific language to prevent what they described as an unintentional de facto cut. No committee vote or formal statutory change occurred during this hearing; providers requested that the Senate restore technical language in the budget bill so nursing facility reimbursement transitions do not produce abrupt funding losses.
Ending: Providers asked lawmakers to adopt the technical fix and consider stop‑loss or blended‑rate approaches during final budget negotiations to soften provider-level reimbursement volatility.
