01/08/2020

ODM Shares Plans for January 1 NF Rates

As reported last week in a LeadingAge Ohio Action Alert, Ohio nursing facilities should be receiving rate packages from the Ohio Department of MEdicaid (ODM) this week detailing their reimbursement rates effective January 1. The rate packages reflect the new quality incentive payment passed in the Ohio biennial budget (HB 166).

In a meeting with LeadingAge Ohio on January 2, ODM staff shared their plans for January 1 reimbursement rates. ODM has confirmed the following, related to the QIP:

• ODM will include all active providers when calculating the “quality pool,” that is, the total funds to be disbursed to eligible nursing homes earning the QIP.
• New providers, as well as those which underwent a change of ownership between January 1, 2018 and December 31, 2019, will be excluded from receiving a quality incentive payment. This is estimated to exclude over 170 nursing homes, which will drive up the price-per-point among those nursing facilities that do receive a quality incentive payment.
• ODM will use the CMS methodology to calculate the four-quarter average in order to arrive at each facility’s point score on each of the four measures.

LeadingAge Ohio encourages NF members to watch their inboxes for rates, and reach out to Susan Wallace, Director of Government Relations & Public Affairs at swallace@leadingageohio.org with any questions. Additionally, hospices should reach out to their nursing facility partners to ensure they have accurate rates for completing January billing.