01/27/2022

ODM shares NF relief calculations, other provider types forthcoming

In a meeting with LeadingAge Ohio yesterday, Ohio Department of Medicaid (ODM) shared their calculations for relief funds appropriated via HB169. Of the $300 million appropriated for nursing facilities, $225 million will be distributed based on 2020 Medicaid days, at a rate of $14.07 per day. For providers with partial cost reports, the Medicaid days will be calculated by the greater of the following: the imputed days, based on the partial year’s data or the statewide average.

The remaining $75 million will be distributed based on the existing quality incentive payment (QIP) formula ,on a per-point-day basis, at a rate of $.36 per point, per day. Notably, ODM will make one change to this formula by not excluding the bottom quartile of providers based on their QIP point scores. For new providers without quality points, ODM will calculate a QIP based on number of beds, statewide average occupancy, utilization and QIP score. For existing operator’s QIP or the calculated statewide average QIP, the state will use the greater of the average beds.

ODM has agreed to share the current draft provider rates with LeadingAge Ohio so that we can share them with members, with the important caveat that these rates are draft and will not be finalized until ODM receives the official federal approval for the relief fund distribution.

LeadingAge Ohio has requested ODM share the same details on calculations being made for other provider types, including assisted living, hospices, adult day and home care providers, and ODM has agreed to do so, though these are not yet ready. As a reminder, PACE relief funds will be provided via a capitation rate adjustment. Questions related to the PRF fund distributions may be sent to Susan Wallace at swallace@leadingageohio.org.