02/17/2022

CMS regulations stall Ohio’s plans for provider relief funds

Note: Since releasing this alert on Tuesday, ODM has further clarified that the 25% of nursing home relief distributed based on the QIP will be distributed on a per-point, per-certified-bed basis, NOT on a per-point, per-day basis. The article below is changed to reflect this. 

On Monday morning LeadingAge Ohio met with officials from the Ohio Department of Medicaid (ODM) to learn the latest updates on ODM’s work to distribute over $1 billion in relief funds to Ohio healthcare providers, including $529 million to home- and community-based providers, $300 million to Ohio nursing homes, and additional funds to assisted living and hospices.

ODM officials had been working with the Centers for Medicare & Medicaid Services (CMS) to develop a methodology for disbursing funds to Ohio providers via the Medicaid payment system, which allows Ohio to benefit from an amplified federal match. However, ODM learned that by processing the funds as Medicaid payments they are subject to additional restrictions, especially as they relate to Medicaid managed care. If done in this manner, CMS would require that any payment calculated based on previous payments (i.e., basing the relief payments on Medicaid utilization during a previous year) must be disbursed using the same mechanisms. This would require Ohio to issue any relief based on care provided via Ohio’s MyCare or managed care programs to first be issued to the managed care plans, then on to providers as a pass-through. Further complicating the process, federal regulations also state that, any time a state wishes to require managed care plans to pay a specified rate or amount to providers, they must first get permission via a specific application or “preprint” to CMS. This process would necessarily delay payments to providers.

As a result of these complications, ODM shared the following modifications to the original plan, with the goal of moving funds to providers as quickly as possible:

• Nursing facilities: the 75% of funds originally proposed to be distributed based on Medicaid days will instead be distributed based on certified beds, effectively circumventing the administrative processes related to managed care. The remaining 25% will be distributed based on the QIP points methodology, but rather than basing it on points-per-day as previously shared by ODM, funds will be allotted based on points-per-bed.
• Home- and community-based services: Providers will receive separate payments for their Medicaid fee-for-service portion and managed care portions of their businesses, with the FFS payment being issued via MITS on a more timely basis, and the managed care payments issued through managed care plans at a delay due to the administrative processes.
• Assisted living: ODM noted that the process for assisted living providers to apply for funds is “very close” to being done. Providers will need to register as a supplier via the OAKS system, which will allow the state to issue 1099 forms to each provider.
• Hospices: CMS has prohibited ODM from distributing all $23 million allocated for hospices, since the majority of it is calculated based on room and board payments and would be a duplicative payment. Instead, an estimated $3.7 million will be distributed via a similar route as home- and community-based providers. Hospices will receive a payment based on fee-for-service Medicaid, followed by payments passed through each of the managed care plans.

ODM noted that in order to secure the enhanced federal match, it anticipates having all payments made by March 31, 2022. However, this deadline does not apply to managed care plans issuing payments to providers.

ODM is planning an additional stakeholder engagement webinar to share an updated relief fund tracking grid with the revised plans and timelines.  In the meantime, LeadingAge Ohio has agreed to field questions and gather feedback on the process. Questions may be directed to Susan Wallace at swallace@leadingageohio.org.