08/24/2023

ODM Clarifies Plans for Case Mix Freeze

This week, the Ohio Department of Medicaid (ODM) shared plans for implementing the case mix changes effective October 1, 2023. HB33 included language which allowed providers to either freeze their case mix, as of March 2023 or to begin using the optional state assessment (OSA) through the remainder of the biennium. 

According to ODM, they are working to finalize the survey tool that will be used for providers to submit their choice to ODM. At this point, the survey is expected to go-live in early September, and will be accompanied by background communication that ODM will also share with LeadingAge Ohio. 

When asked whether ODM will use a rolling six-months of case mix scores (i.e., December 2022 and MArch 2023 case mix), ODM stated that HB 33 language specifically states that March 2023 case mix scores will be used for those who chose to freeze their case mix score, implying they will only use the first-quarter case mix. 

Additionally, officials from the Bureau of Program Integrity confirmed that Exception Reviews will continue as before, sampling both those providers who choose to freeze their case mix and those that opt for the OSA and will share more information about their workplan once providers have made their selections.   

Finally, several measures used in the Medicaid Quality Incentive Payment (QIP) are calculated based on Section G items. HB 33 included language that would allow ODM to rely on any future, successive measures that would follow once Section G is phased out. The Centers for Medicare & Medicaid Services (CMS) have yet to release their plans regarding anticipated changes to the measure specifications. The measures that currently rely on section G are the “ability to move worsens” and “decline in ADLs”.

Providers weighing the choice to freeze the case mix may consider the following factors: 

In considering whether to freeze or not, definitely look at your case-mix scores and think about these questions:

• What is your March case-mix score?
• Does this trend right for your facility? Was it lower than previous quarters? What it representative of your population?
• Does March case-mix take into account resident changes that won’t be there in the future such as isolation related to COVID?
• Do you anticipate higher case-mix scores going forward (i.e. new experienced MDS nurse so MDS will be more accurate?)
• Is it sustainable to complete OSAs in addition to the OBRA requirements?
• Would you reallocate the MDS nurse time if not completing OSAs? For example, would their time be better spent focused on appropriate coding to improve the quality incentive payment? 
• How confident are you in point of care documentation? You would be maintaining Section G documentation which is a top area that ODM takes money back from via MDS exception reviews. 

Questions regarding the upcoming case mix changes may be directed to Stephanie DeWees, Quality Specialist for Long-term Care at sdewees@leadingageohio.org.