The Ohio House Medicaid Committee this week unveiled the first phase of a sweeping Medicaid anti-fraud package as lawmakers continue responding to heightened scrutiny surrounding home- and community-based services and other Medicaid-funded programs.
House Bill 795, originally focused on electronic visit verification requirements, was expanded into a wide-ranging Medicaid oversight proposal that House leaders say is intended to “stop the bleed” while additional reforms are developed later this year.
Committee leaders indicated the legislation is moving quickly, with additional hearings planned next week and a possible House floor vote in early June.
The substitute bill includes numerous new enforcement and oversight provisions, including increased criminal penalties for Medicaid fraud, more frequent provider agreement renewals, enhanced provider screening requirements, mandatory investigations tied to suspicious billing patterns, expanded data-sharing authority, and stronger front-end verification measures for high-risk providers.
Lawmakers and agency officials repeatedly emphasized that the focus must remain on identifying bad actors without creating unnecessary burdens for quality providers serving Ohioans appropriately and ethically.
“This is not the end-all, be-all fix,” House Medicaid Committee Chair Rep. Jennifer Gross said during the hearing. “We’ll do our best not to harm the good actors in our system.”
Testimony throughout the hearing highlighted the growing focus on front-end prevention, provider transparency, ownership disclosure, and stronger enrollment safeguards — themes that closely align with LeadingAge Ohio’s recent hospice integrity work.
Last week, LeadingAge Ohio-backed House Bill 945 was introduced to strengthen hospice oversight and accountability in Ohio. Developed in collaboration with fellow stakeholders, nonprofit hospice leaders, the Ohio Department of Health, and Rep. Andrea White, the legislation includes enhanced licensure standards, stronger ownership transparency requirements, criminal background checks, expanded quality monitoring, and additional enforcement authority designed to prevent questionable operators from entering or exploiting Ohio’s hospice system.
LeadingAge Ohio has consistently supported thoughtful, targeted oversight measures that protect Medicaid resources while preserving access to high-quality care. The association has emphasized that mission-driven providers welcome appropriate accountability measures that reinforce public trust and help distinguish responsible providers from bad actors.
During Wednesday’s hearing, lawmakers, the attorney general’s office, State Auditor Keith Faber, and Ohio Medicaid Director Scott Partika all stressed the importance of stronger front-end controls, better data sharing, and earlier intervention to prevent fraud before taxpayer dollars are lost.
At the same time, several lawmakers and advocates cautioned against policies that could unintentionally create barriers for individuals relying on home- and community-based services. Discussions also highlighted the operational realities providers face with electronic visit verification systems, administrative requirements, and workforce shortages.
House leaders described the legislation as only the beginning of broader Medicaid integrity discussions expected to continue throughout the year. You Asked: How often do menus have to be changed?
We Answered: Under §483.60(c)(5), nursing home menus must be updated periodically. CMS explains that periodically means that a facility should update its menus to accommodate their changing resident population or resident needs as determined by their facility assessment. This includes considering residents’ ethnic, cultural, or religious factors that may potentially affect the care provided by the facility, including, but not limited to, activities and food and nutrition services.
Rather than requiring menu changes on a specific schedule, CMS expects facilities to ensure menus continue to meet the needs and preferences of their current residents. During surveys, residents may be asked whether they have meaningful choices about meals and beverages and whether the facility honors their preferences regarding mealtimes, food selections, and fluid choices. Facilities should be prepared to demonstrate how resident input is gathered and incorporated into menu planning. Top What happens when a former beauty industry marketer discovers a mission far more meaningful than cosmetics? In the latest episode of Another Word for Living, host Susan Wallace talks with nationally-recognized palliative care advocate Dr. Marian Grant, about her pathway from marketing makeup with supermodels to championing palliative care, which Grant calls “the best product” she has ever sold. The conversation debunks conventions in how we talk about palliative care and highlights how a strong message can build understanding around serious illness, supportive care, and the value of palliative care for individuals and families.
Wallace and Grant also explore how language influences what people think palliative care is, when it should begin, and why clearer communication matters. They discuss the work behind Serious Illness Messaging and why choosing the right words can help more people understand the support available to them.
Listen to Another Word for Living on all major podcast platforms. Last week, LeadingAge Ohio hosted palliative care experts from across the state for a day of learning, strategy and consensus-building around policy priorities for the year to come.
During the second-annual Palliative Care Summit, LeadingAge debuted its Palliative Care Playbook, developed from conversations with health plans and community-based palliative care providers following last year’s summit, where there was a clear need to provide more promote understanding of community-based palliative care among health plans and provide a ladder for programs to build their care model.
The Summit also marked the launch of LeadingAge Ohio’s new palliative care membership, inviting new programs to the table, including pediatric palliative care programs and hospital-based programs. This membership will allow providers to speak with a unified advocacy voice and continue to steer the work of serious illness care in the state of Ohio.
Existing members that operate palliative care programs are grandfathered into the new membership level. Providers interested in palliative care membership should download the membership application and reach out to Susan Wallace at swallace@leadingageohio.org to get more involved in LeadingAge Ohio’s palliative care advocacy. LeadingAge Ohio is accepting nominations for its 2026 Annual Awards, which recognize member organizations and individuals whose work reflects leadership, innovation, service, and a strong commitment to older Ohioans. Awards will be presented during the LeadingAge Ohio Annual Meeting this fall, and nominations are open through May 29, 2026. Member organizations may nominate colleagues, staff, volunteers, or their organizations across five categories: the Aging Services Impact Award, Emerging Leader Award, Excellence in Caring Award, Visionary Leadership Award of Honor, and the Heart of Hospice-Rose and Sam Stein Award.
LeadingAge Ohio is also accepting nominations for the 2026 Hall of Changemakers display at Annual Conference. Created for this year’s conference theme, Celebrating the Changemakers, the recognition highlights individuals or member organizations whose influence has made a lasting difference in a life, workplace, or community. Honorees will be featured in the Hall of Changemakers display during the conference.
For award criteria, nomination forms, and submission details, visit the 2026 Annual Awards nomination page. Questions may be directed to Molly Homan, Director of Operations, at mhoman@leadingageohio.org. Top LeadingAge’s 16 Member Networks and 13 Peer Groups, covering a wide range of job, care setting, and community-specific categories, as well as interest areas like technology, workforce and quality and risk management, provide valuable access to knowledge and insights from colleagues at mission-driven organizations nationwide. Explore them and sign up—here’s how. Top The Ohio Department of Aging is inviting directors of nursing and medical directors to join its EXCEL Academy Communities of Practice, monthly virtual programs created for both new and experienced leaders.
- The DON sessions focus on resident quality of life, peer discussion, and professional development, with interactive conversations led by seasoned directors of nursing from the Ohio Department of Aging’s Quality Initiatives Division and Engage Consulting. Both the May and June sessions have been approved for continuing education hours through BELTSS. While the first session launched today, memers can still get involved in the June 25 session on effective delegation as a director of nursing. Sessions are held virtually on Microsoft Teams, last 45 minutes, and future meetings will continue on the fourth Thursday of each month at 2 p.m. Questions may be directed to the EXCEL team.
- The Medical Director Community of Practice today focused on national trends in advance practice provider collaboration, and June 25 will focus on long term care and artificial intelligence.
Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz joined Gov. Mike DeWine at Hopewell Elementary School in Dublin this week. During the visit, Oz and DeWine addressed recent scrutiny of Ohio Medicaid, including allegations of fraud involving home health providers and the state’s response, which has included freezing some payments while investigations continue.
The Statehouse News Bureau also reported on Oz’s comments about the administration’s broader anti-fraud efforts and his stop in Ohio as state leaders continue debating possible Medicaid reforms. See the full article from the Statehouse News Bureau. Top A nursing facility must notify the state mental health authority or state intellectual disability authority promptly after a significant change in the mental or physical condition of a resident who has mental illness or intellectual disability for resident review. One commonly overlooked requirement is the facility's obligation to notify the appropriate state mental health or intellectual disability authority when a significant change in the resident's physical or mental status occurs.
Under F646, any resident with newly evident or possible serious mental disorder, ID or a related condition must be referred, by the facility to the appropriate state-designated mental health or intellectual disability authority for review. Examples of individuals who may not have previously been identified by PASARR to have MD, ID or a related condition include:
- A resident who exhibits behavioral, psychiatric, or mood related symptoms suggesting the presence of a mental disorder (where dementia is not the primary diagnosis).
- A resident whose intellectual disability or related condition was not previously identified and evaluated through PASARR.
- A resident transferred, admitted, or readmitted to a NF following an inpatient psychiatric stay or equally intensive treatment.
Surveyors may review facility processes to determine whether required PASARR notifications and referrals were completed timely and whether documentation supports compliance with state notification requirements. Facilities should ensure staff understand what constitutes a significant change and maintain documentation demonstrating when notifications were made and any resulting recommendations or determinations received from the state authority. The Ohio Department of Medicaid has shared several additional Civil Money Penalty Reinvestment Projects seeking nursing home participants, all of which qualify as quality improvement projects. Opportunities include
- The Java Project, which focuses on social isolation through resident discussion groups and includes full grant-funded training with no ongoing fees. Providers interested in The Java Project may contact Dr. Kristine Theurer;
- Bingocize®, an evidence-based program that combines bingo, exercise, and health education to support mobility, fall reduction, and social engagement;
- The iCARE Dementia Project, which offers dementia training and support for staff pursuing Certified Dementia Practitioner® certification. Communities interested in iCARE may contact Juliet Kerlin and
- Te Furry Friends Project, which would provide up to 28 robotic companion pets to residents with dementia or residents experiencing depression or loneliness, along with training and project management. Members interested in Furry Friends may contact Khadijah Lewis.
These programs launch as Ohio has newly reopened its Civil Monetary Fund Reinvestment Program. Questions regarding the program may be directed to CMPRP@medicaid.ohio.gov. Top Congratulations to LeadingAge Ohio member Senior Living by Youngstown Area Jewish Federation on national recognition for two of its communities. Heritage Manor Skilled Nursing & Rehabilitation and Levy Gardens Assisted Living were named in Business Journal Daily’s coverage of the 2026 U.S. News & World Report Best Senior Living ratings. This marks the second consecutive year Heritage Manor has been recognized.
The recognition reflects feedback from residents and families and speaks to the work these teams do every day to provide high-quality care and services. Heritage Manor is also a five-star skilled nursing facility under the Centers for Medicare & Medicaid Services and recently completed a deficiency-free survey. Levy Gardens offers assisted living in private apartments designed to support both independence and peace of mind. Congratulations to the staff and leadership at both communities on this well-earned recognition. Top LeadingAge Ohio holds valuable education webinars and in-person events throughout the year. Opportunities are added weekly. See the complete Schedule of Events. Top Assisted living providers that are currently contracted to bill for the critical access rate are required to respond to the Ohio Department of Aging’s annual June survey. To maintain HIPAA compliance, the Critical Access Rate document must be uploaded through ShareFile because it contains Medicaid recipient information. The document is available on the Ohio Department of Aging’s Assisted Living Waiver Providers page under the critical access rate section. Providers must email Angie Jenkins by June 22, 2026, with the provider name, provider address, the first and last name of the individual responsible for sending the document, and that person’s email address in order to receive a ShareFile link.
Without that information, providers will not be able to submit the Critical Access Rate document and will not be approved to bill for the critical access rate during the next state fiscal year. Assisted living providers certified by the Ohio Department of Aging may qualify to bill for the critical access rate under Ohio Administrative Code 173-39-02.16(E). The rate is $145 per day and the billing code is T2031U2. The Critical Access Rate document must be submitted to the Ohio Department of Aging by July 31, 2026, to bill for state fiscal year 2027. Questions may be sent to Angie Jenkins. Top
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