The Ohio Department of Medicaid (ODM) outlined changes coming to nursing facilities that provide ventilator services, following concerns about billing practices misaligned with program intent.
During a stakeholder meeting on February 19, ODM shared that proposed rule changes will likely:
- Establish formal definitions for invasive and non-invasive ventilator modalities
- Require respiratory therapist staffing
- Implement prior authorization for complex non-invasive interventions
- Require annual reporting on provider-picked resident health outcomes
- Establish a new three-tier rate system, with BiPAP and CPAP receiving no reimbursement, complex non-invasive treatment reimbursed with a daily add-on rate, and invasive ventilation and vent weaning reimbursed under an enhanced rate.
The changes stem from state concerns that the ventilator program, originally designed to support residents with invasive ventilator needs, is being billed for less acute uses, including residents using BiPAP therapy.
LeadingAge Ohio learned of concerns with the ventilator program in late January and quickly convened members who provide these services. Drawing on member expertise, LeadingAge Ohio submitted recommendations to ODM focused on program integrity and appropriate care. ODM plans to include recommendations, such as respiratory therapy staffing, in its rule change. Other recommendations were discussed with the stakeholders on the call.
What’s next
ODM is sending a survey to providers participating in the vent program within the next week. After reviewing survey results, ODM will issue the proposed rules for public comment. LeadingAge Ohio will continue to engage with the department and keep members informed as additional details become available. Ohio Medicaid Director Scott Partika briefed lawmakers this week on the wide-ranging impact of H.R. 1, the federal Medicaid reform law enacted in July 2025, outlining changes to eligibility rules, financing structures and program integrity requirements that will phase in over the next several years.
Testifying before a joint meeting of the House and Senate Medicaid committees, Partika said the law requires Ohio to implement several new eligibility policies, including six-month redeterminations for expansion adults and mandatory work and community engagement requirements beginning by the end of 2026. Approximately 70,000 Ohioans could be affected by the work requirements.
On the financing side, Partika said federal restrictions on provider taxes and state-directed payments will have longer-term budget implications. Ohio’s hospital franchise fee and managed care organization tax will face phased reductions, and state-directed payments will gradually move toward Medicare-equivalent limits.
He also warned that changes to the federal PERM audit process beginning in 2029 could expose Ohio to significant financial penalties if payment error rates exceed federal thresholds.
During the hearing, Rep. Tim Barhorst (R- Fort Loramie) asked about the Ohio Supreme Court’s recent mandamus ruling related to nursing facility rates and the Quality Incentive Program, noting he has received calls from nursing home providers seeking clarity.
Barhorst asked directly whether rates are being recalculated and when providers might expect distributions.
Partika acknowledged the volume of inquiries and said the department has been in close communication with nursing home associations since the ruling.
He stated ODM is conducting due diligence to balance the Supreme Court’s decision with the statutory language enacted by the General Assembly at the end of 2025 in House Bill 184. He indicated that the Department is working closely with Governor Mike DeWine and that the next step will likely involve discussions between the Governor and legislative leadership on how to proceed.
However, Partika said he could not provide a specific timeline for recalculated rates or distribution of back payments at this time.
Director Partika’s testimony and presentation can be found here. Top You Asked: When must a fire watch be initiated if the fire alarm system is down?
We Answered: A fire watch must be implemented when a facility’s fire alarm system is out of service for more than four (4) hours within a 24-hour period, or when the automatic sprinkler system is out of service for more than ten (10) hours within a 24-hour period. Facilities are expected to have a written fire watch plan that outlines staff responsibilities, monitoring frequency, documentation expectations, and notification procedures during the impairment period. The Ohio Department of Health has developed a Fire Watch Procedures Template that facilities may use as a guide when developing or revising their policy and documentation tools. Top If you missed Monday’s Advocacy in Action, the recording is now available for members.
During the February 16 training, the LeadingAge Ohio policy team provided training and resources for members on how they can advocate and educate lawmakers on the need for swift appropriations for QIP recalculations and back payments, as well as legal next steps members can take should both continue to be delayed.
Members can access the advocacy toolkit here, which includes fact sheets for members’ board of directors, talking points, sample legislator communication, and a legislator leave-behind. The STARS Awards shine a well-deserved spotlight on your frontline, non-management team members who make a difference every single day. From nursing assistants and dining staff to housekeepers, maintenance teams, and program staff, these individuals represent the heart of mission-driven aging services across Ohio.
Each member organization may nominate up to 6 employees per site location to be honored at one of four regional luncheons this spring. We encourage facilities to recognize their outstanding team members whose service reflects compassion, professionalism, and commitment to quality care. Nominations can come from management, coworkers, residents, and resident families.
Find more information on the program, including dates and locations, on the LeadingAge Ohio website and check out the STARS Nomination and Ceremony Guide for eligibility details, deadlines, and instructions before submitting nominations.
Questions can be directed to Molly Homan at mhoman@leadingageohio.org. LeadingAge Ohio’s Regional Network Gatherings return this spring, offering members the opportunity to connect with peers from across the state. These in-person gatherings center on conversation and relationship-building among mission-driven aging services organizations.
Join us at one of the networking events from 4 p.m. to 6 p.m.:
Thank you to Platinum Partner Link-age Solutions for their continued sponsorship of the Regional Network Gatherings!
Attendance is free for LeadingAge Ohio member communities. Associate firms and partners are welcome to attend for a fee. Contact Corey Markham at cmarkham@leadingageohio.org for details. Did you know that LeadingAge’s free NurseLEAD program teaches nursing leaders how to coach their teams and manage conflict? This powerful training offers an implementation guide and companion activities to ensure the learning is incorporated into daily practice; case studies; and additional resources. Enroll your team today! There's always something happening at LeadingAge Ohio, view all upcoming events here and mark your calendar today!
- February 26, 1 p.m. - Managing Food, Cost, and Waste in Long-Term Care with LeadingAge Dakota
- March 4, 11 a.m. - Affordable Housing Subcommittee
- March 5, 10 a.m. - Advocacy Committee
- March 10, 11 a.m. - Strategic HR Leadership Series
- March 11, 11 a.m. - STAT 2026: Care Planning Compliance
- March 12, 9 a.m. - 2026 Finance Strategy Workshop
- March 16, 10 a.m. - Advocacy in Action
- March 18, 11 a.m. - From Vision to Practice: Planning for Inclusion
- March 19, 1 p.m. - 2026 Reimbursement Collaborative: Documentation that Drives Reimbursement
Top The early-bird discount for the 2026 Leadership Summit ends next week, February 26.
Federal decisions are reshaping Medicare, Medicaid, housing, and workforce policy for nonprofit aging services providers. The Summit offers focused briefings on the future of Medicare benefits for home health and hospice, Medicaid changes, Medicare Advantage, affordable senior housing, national workforce priorities, home- and community-based services, nursing home policy updates, and more.
More than 700 aging services leaders will gather April 20–22 in Washington, DC, for this national policy event. Register now to secure the early-bird rate. Top Ohio Attorney General Dave Yost this month announced an expanded statewide effort to protect older Ohioans from abuse, neglect, and financial exploitation. According to a recent Attorney General news release, the initiative builds new partnerships and training opportunities aimed at strengthening prevention and reporting across the state.
Media coverage notes a reported 400 percent increase in elder abuse cases over the past seven years, underscoring the urgency behind the effort, as detailed in this 13abc report.
Learn more about resources and information here. Two new long-term care reports from the Ohio Department of Aging and the Scripps Gerontology Center at Miami University document a 30-year shift in how Ohioans receive services and supports. The studies, part of the Ohio Long-Term Care Research Project, find that far more people with significant disabilities are receiving care at home and in community settings rather than in nursing facilities. Three decades ago, nine in 10 older Ohioans with high disability levels received care in a nursing home; today, most receive services in the community. The companion nursing home profile outlines changes across Ohio’s 930 facilities, including growth in short-term rehabilitation, workforce recruitment challenges, and continued reliance on public funding. Both reports are available through the Ohio Department of Aging.
Read the original announcement from the Ohio Department of Aging. Top The U.S. Department of Health and Human Services has formally withdrawn its proposed 340B Rebate Model Pilot Program following federal court rulings that blocked implementation. At the same time, the Health Resources and Services Administration (HRSA) has issued a new Request for Information (RFI), reopening debate over whether the 340B program should move from upfront discounts to a rebate model.
What happened
- HRSA’s 2025 pilot would have required covered entities to pay full Wholesale Acquisition Cost upfront and seek rebates later from manufacturers.
- Hospital groups, including the American Hospital Association, challenged the model in federal court.
- A U.S. District Court blocked the pilot in December 2025, citing deficiencies in the agency’s administrative record.
- The federal government later moved to vacate the program entirely rather than continue litigation.
- Result: The pilot is withdrawn. The current upfront discount structure remains in place.
What HRSA is asking now
The February 13, 2026 RFI signals a reset, not abandonment. Submit comment by March 19, 2026.
HRSA is seeking feedback on:
- Whether the 340B statute permits a rebate model instead of upfront discounts
- Cash-flow implications for covered entities
- Administrative costs, staffing, and IT system changes
- Safeguards to prevent inappropriate rebate denials
- Potential program integrity concerns
No new rule has been proposed. This is an information-gathering stage.
Why it matters to nonprofit aging services providers
Many nonprofit hospitals and health systems that participate in 340B partner with or operate:
- Hospice programs
- Skilled nursing facilities
- Life plan communities
- Outpatient clinics serving older adults
A rebate model could:
- Delay access to drug savings
- Increase short-term borrowing or working capital needs
- Add compliance and billing complexity
- Affect service capacity for mission-driven providers operating on narrow margins
For Ohio providers connected to 340B-covered entities, the financial structure of the program directly affects sustainability.
What’s next
- HRSA will review comments submitted by March 19.
- Future rulemaking is possible but not guaranteed.
- Any structural change would likely require a formal regulatory process.
Top Survey deficiencies related to discharge planning commonly occur when the process is treated as an end-of-stay task rather than an ongoing, individualized component of the comprehensive care plan. The Long-Term Care Survey Process requires surveyors to review a discharge record. Under §483.21(c)(1), discharge planning is expected to begin at admission and continue throughout the resident’s stay, based on the resident’s assessed needs, goals for care, desire to be discharged, and capacity for discharge. Surveyors frequently cite facilities when discharge planning is incomplete, poorly documented, or not reflective of the resident’s current condition and goals.
According to the State Operations Manual (SOM) Appendix PP, discharge planning is an interdisciplinary process that requires active involvement of the resident and, when applicable, the resident representative. Surveyors evaluate whether the discharge care plan is integrated into the comprehensive care plan and whether it addresses the resident’s stated goals, treatment preferences, and anticipated post-discharge needs. Failure to demonstrate resident involvement or meaningful interdisciplinary input is a common area of noncompliance.
Surveyors also assess whether facilities identify and address barriers that must be resolved prior to discharge, such as the need for resident or caregiver education, rehabilitation services, or caregiver support and training. Discharge plans that do not account for changes in the resident’s condition or that are not updated when goals or needs change may be cited, particularly when avoidable complications occur. Inadequate discharge planning may lead to poor transitions, increased risk of rehospitalization, or other adverse outcomes following discharge.
The discharge care plan must document the resident’s interest in discharge and include evidence of referrals to the local contact agency, when applicable. Surveyors will review whether facilities have identified necessary post-discharge services and support, such as nursing or therapy services, medical equipment, home modifications, or assistance with activities of daily living.
During survey, reviewers will trace how discharge planning decisions were made and whether the facility proactively reassessed discharge readiness over time. Facilities are expected to demonstrate that discharge planning is a dynamic process designed to support a safe and successful transition, rather than a last-minute administrative step. When discharge planning is individualized, regularly reassessed, and clearly documented, it supports compliance and reduces the risk of adverse outcomes following discharge. The Centers for Disease Control and Prevention (CDC) has released new and updated tools to support long-term care providers during respiratory virus season and to strengthen sepsis prevention efforts in nursing homes.
The agency’s new Long-Term Care Respiratory Virus Factsheet is designed for residents, families, and visitors. The handout explains steps facilities may take during respiratory virus season to protect resident health and reduce transmission. Providers can download the factsheet and related materials through the Prepare for Respiratory Viruses section of the Viral Respiratory Pathogens Toolkit for Nursing Homes.
The CDC also introduced a Sepsis Prevention Assessment Tool (SPAT) for Nursing Homes, recognizing that nursing home residents face an elevated risk of infection and sepsis due to underlying medical conditions and frequent healthcare interactions. The tool helps facilities identify gaps in sepsis policies, staff training, and clinical practices. It includes instructions for conducting the assessment, analyzing findings, sharing results internally, and planning next steps to improve infection prevention and early recognition. Sen. Ron Wyden (D-OR), ranking member of the Senate Finance Committee, on February 12 introduced the Nurses Belong in Nursing Homes Act (S. 3886), legislation that would establish federal minimum staffing standards for nursing homes.
The bill mirrors the now-repealed Minimum Staffing Standards for Long-Term Care Facilities rule. It would require 3.48 hours per resident per day of total nurse staffing, along with registered nurse coverage twenty-four hours per day, seven days per week.
LeadingAge opposes the legislation, citing concerns about workforce availability and the impact on nonprofit providers. Read more here. Top United Church Homes has received two grants totaling $15,000 to expand access to its NaviGuide service coordination program for low-income older adults and their families in the Columbus area. The funding includes $10,000 from The Columbus Foundation through the Edythe G. Alberty Fund and $5,000 from The Harry C. Moores Foundation to subsidize participation for individuals who would otherwise be unable to afford the $99 monthly fee.
Launched four years ago, NaviGuide provides individualized support to older adults and their adult children as they navigate health care, housing, and community-based services. With this funding, United Church Homes expects to assist approximately 51 older adults in Franklin and Delaware counties for up to three months. In 2024, similar subsidies helped secure housing for a formerly homeless older adult, reconnect individuals to in-network medical and dental providers, and support Medicaid renewals. Headquartered in Marion, United Church Homes serves more than 7,000 residents across 90 communities in 15 states and two tribal lands. Learn more about NaviGuide and United Church Homes. Ohio Living has expanded its dementia-focused services with the addition of Ohio Living Ganzhorn Suites in Powell.
The community, formerly The Ganzhorn Suites of Powell, specializes in serving individuals living with dementia through a model grounded in dignity and individualized support. Now operating as Ohio Living Ganzhorn Suites, the location joins the Ohio Living family while maintaining its specialized approach and experienced team.
The addition strengthens Ohio Living’s nonprofit commitment to high-quality dementia care and broadens its reach in central Ohio. Top Have you looked at your food program lately and wondered how you could reduce costs without sacrificing quality? LeadingAge communities can enhance the dining experience for their residents and improve their bottom line at the same time. Learn more by clicking here. LeadingAge Ohio holds valuable education webinars and in-person events throughout the year. Opportunities are added weekly. See the complete Schedule of Events. Top
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