You Asked... We Answered

You Asked: Does breakfast have to be served within 14 hours of the dinner?

We Answered: The timeliness of breakfast depends on whether the facility qualifies for the CMS exception. Without a nourishing bedtime snack, breakfast must be served within 14 hours of the substantial evening meal. If a nourishing bedtime snack is served and the resident group agrees to the schedule, the interval may be extended to 16 hours. This requirement is found in SOM Appendix PP and in federal code §483.60(f)(2).

Nurses: Prepare for 2027 Continuing Education Changes

Ohio nurses must meet specific continuing education requirements to renew their licenses, and rule changes taking effect with the 2027 renewal cycle will alter what they need to track. Join LeadingAge Ohio for Nursing Law webinar from 1 to 2 p.m. September 22 for a focused review of Ohio Administrative Code Chapter 4723-14, license renewal requirements, qualifying continuing education and common misunderstandings that may affect compliance.

Participants will hear from Brittany Turner, MSN, RN, CNEcl, NPD-BC, director of continuing education at the Ohio Nurses Association. The session will explain the 2026 rule changes and help nurses prepare before the next renewal cycle. The Ohio Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Register for the Nursing law webinar.

Maximize Your Membership: LeadingAge’s NEW Clinical Procedure Manual, 23rd Edition

Newly updated in 2026, more than 300 clinical procedures to ensure high-quality and consistent care delivery. The LeadingAge Clinical Procedure Manual (CPM) is a must-have tool for providers committed to ensuring high-quality care. Procedures are the backbone of clinical practice. Providers can use the CPM to ensure they are performed with reliable consistency by every clinician, every time. From activities of daily living to clinical tasks to safety and wound care, the manual covers a wide range of procedures that home and community-based and other providers deliver every day. Members receive a 30% discount. Read more about the manual, including a list of procedures and a sample chapter here.

LeadingAge Seeks Member Input Ahead of GAO Meeting on Medicare Advantage

LeadingAge will meet with the Government Accountability Office in August to discuss Medicare Advantage provider networks and contracting practices affecting skilled nursing, home health and other post-acute care providers. LeadingAge Ohio members are encouraged to share experiences involving network participation, contract negotiations, prior authorization, delayed transitions to post-acute care, out-of-network services and continuity of care.

Feedback does not need to address every question. Members may submit any relevant examples or concerns to Nicole Fallon by the end of the day Wednesday, Aug. 5. LeadingAge plans to share member feedback with the Government Accountability Office and other federal policymakers.

Read the full LeadingAge request and list of questions.

Ohio Department of Medicaid Previews Behavioral Health Rule Changes for Long-Term Care Settings

The Ohio Department of Medicaid (ODM) has outlined proposed changes to behavioral health services provided in nursing facilities and assisted living settings as part of its broader effort to strengthen Medicaid program integrity. The department said it has seen a significant increase in billing for certain behavioral health services and is proposing rule changes intended to address potential fraud, waste, abuse, and duplicative services.

The proposed rules, which are expected to be released for public comment in October with a target implementation date of January 1, 2027, would make several significant changes affecting providers serving residents in long-term care settings.

Among the changes ODM discussed:

• Therapeutic Behavioral Services (TBS) provided in nursing facilities would require prior authorization beginning with the first day of service.
• Psychosocial Rehabilitation (PSR) would no longer be reimbursable in nursing facilities because ODM believes the service is intended to help individuals maintain independent living in community settings.
• Behavioral health nursing services also would no longer be reimbursable in nursing facilities, with ODM citing concerns that these services may duplicate nursing care already provided by the facility.
• ODM is proposing clearer definitions for TBS and PSR to distinguish each service's intended purpose and expected outcomes.

During the webinar, department staff emphasized that Medicaid behavioral health services must be medically necessary and tied to individualized treatment plans. They also reiterated that recreational activities, entertainment, routine socialization, snacks, meal breaks, and similar activities are not Medicaid-covered behavioral health services.

ODM indicated the proposed rules are part of a broader review of behavioral health services across the Medicaid program and said providers will have an opportunity to submit comments once the formal rule package is released this fall.

LeadingAge Ohio is monitoring these proposals closely. If your organization serves a significant behavioral health population in a nursing facility or assisted living setting, we encourage you to contact us. We want to better understand how these proposed changes could affect resident care, operations, and access to needed behavioral health services as the rulemaking process moves forward. 

ODM’s slide deck presentation from the webinar can be found here. 

CMS Medicaid Fraud Initiative Flags $203 Million in Payments

The Centers for Medicare & Medicaid Services says its Medicaid Fraud War Room identified 50 high-risk providers associated with $203.3 million in potentially improper Medicaid payments during its first 88 days. The U.S. Department of Health and Human Services Office of Inspector General issued 42 notices of intent to exclude providers, while states took 15 enforcement actions. Seven providers were subject to both.

The initiative uses billing data and federal-state coordination to identify suspicious claims and pursue enforcement. Medicaid providers should continue reviewing billing practices, enrollment records, and exclusion screening procedures. Read the full CMS announcement.

Survey Tip of the Week: Resident and Facility Pets

Pets can enhance quality of life, reduce loneliness, and contribute to a more homelike environment for nursing home residents. Facilities that allow resident or facility pets must ensure appropriate safeguards are in place to protect the health, safety, and rights of all residents. The Ohio Administrative Code 3701-17-09(D) requires facilities that allow resident pets or maintain facility pets to consult with the medical director and a licensed veterinarian and develop a written protocol. At a minimum, the protocol must address:

• Annual physical examinations, including parasite screening;
• Vaccinations, including rabies;
• Preventive veterinary care;
• Procedures for animal bites, illness, or injury;
• Care of resident pets when the resident is transferred, discharged, or otherwise unable to care for the pet;
• Designation of staff responsible for facility pets and maintenance of veterinary records; and
• Evaluation of residents' medical needs related to the presence of animals.

In addition to meeting Ohio requirements, facilities should ensure their pet program addresses the applicable federal requirements found in the CMS State Operations Manual (SOM), Appendix PP, including:

• F550 – Resident Rights, supporting resident choice and quality of life;
• F584 – Safe, Clean, Comfortable, and Homelike Environment, ensuring pets do not detract from a clean, comfortable living environment;
• F689 – Free of Accident Hazards, ensuring animals do not create risks such as bites, scratches, falls, or other safety concerns; and
• F880 – Infection Prevention and Control, ensuring appropriate vaccination, hygiene, waste disposal, and infection prevention practices are implemented.

LeadingAge Ohio reminds members to review the pet policy annually to ensure it complies with Ohio requirements and reflects current practices. Verify veterinary records are current, staff understands their responsibilities, residents' medical needs (such as allergies, immunocompromised conditions, or fear of animals) have been considered, and infection prevention and emergency procedures are incorporated into the facility's overall safety program. A well-managed pet program can support resident quality of life while demonstrating compliance with both state and federal expectations.

CMS Finalizes 2.4% SNF Payment Update for Fiscal 2027

The Centers for Medicare & Medicaid Services issued its fiscal year 2027 Skilled Nursing Facility Prospective Payment System final rule on July 29. The rule finalizes Medicare payment updates and changes to the Skilled Nursing Facility Quality Reporting Program and Value-Based Purchasing Program.

The rule is scheduled for Federal Register publication July 31. The payment update and other fiscal year 2027 provisions take effect Oct. 1, while several quality reporting changes will begin in later program years.

What You Need To Know

• Medicare payment rates will increase by 2.4%. The update reflects a 3.3% market basket increase, reduced by a 0.9 percentage-point productivity adjustment. CMS estimates aggregate payments to skilled nursing facilities will increase by approximately $882.74 million in fiscal year 2027.
• Two COVID-19 vaccination measures will be removed. Beginning with the fiscal year 2028 Skilled Nursing Facility Quality Reporting Program, CMS will remove vaccination coverage measures for health care personnel and residents.
• The quality reporting submission window will be shortened. Beginning with the fiscal year 2029 program, the current 4.5-month submission period will be reduced to approximately 45 days. CMS expects the change to reduce the delay between data submission and public reporting by up to three months.
• Minimum Data Set reporting will expand. Skilled nursing facilities will be required to submit Minimum Data Set information for all residents receiving covered skilled care, regardless of payer.
• Value-Based Purchasing adjustments remain separate from the payment increase. CMS estimates fiscal year 2027 Skilled Nursing Facility Value-Based Purchasing adjustments will result in a net payment reduction of approximately $203.60 million for affected facilities.
• CMS did not finalize Patient Driven Payment Model changes. The agency requested feedback on possible payment model updates addressing case-mix coding and will consider the comments in future rulemaking.

What Happens Next

• The fiscal year 2027 payment update takes effect Oct. 1. CMS has posted the final rule and supporting payment files, including the wage index, Patient Driven Payment Model case-mix rates and ICD-10 mapping files.
• The quality reporting changes will be phased in. The vaccination measures will be removed beginning with the fiscal year 2028 program. The shorter submission timeframe will begin with the fiscal year 2029 program.
• CMS will align Value-Based Purchasing snapshot dates with the new reporting deadlines. The change will apply to two measures calculated with Minimum Data Set assessment information, beginning with fiscal year 2027 data.
• Additional changes could follow through future rulemaking. CMS will consider comments related to advance care planning measures and possible Patient Driven Payment Model revisions addressing case-mix coding. No new requirements were finalized for either issue in this rule.

What to Do

• Model the facility-level financial impact. Apply the 2.4% national update alongside the organization’s wage index, resident case mix and expected Value-Based Purchasing adjustment. Use the fiscal year 2027 payment and classification files when preparing budget projections.
• Review quality reporting workflows now. Identify how clinical, reimbursement, health information and quality teams will meet the future 45-day submission window. CMS maintains current dates and reporting instructions on its Skilled Nursing Facility Quality Reporting Program submission deadlines page.
• Prepare for expanded Minimum Data Set reporting. Review current assessment processes, payer classifications and software capabilities to determine what changes will be needed. CMS posts current coding instructions and updates in the Minimum Data Set 3.0 Resident Assessment Instrument Manual.
• Confirm access to reporting systems and reports. Ensure appropriate team members can use the Internet Quality Improvement and Evaluation System to submit assessments and review facility reports.
• Review Value-Based Purchasing performance. Compare current results with the eight measures used for the fiscal year 2027 program and review quarterly confidential feedback reports through iQIES. CMS provides measure, payment and program information on its Skilled Nursing Facility Value-Based Purchasing Program page.
• Check Patient Driven Payment Model coding and documentation. Review interdisciplinary documentation and classification practices for consistency with CMS guidance. The agency’s Patient Driven Payment Model resources include training materials, fact sheets and technical information.

LeadingAge will be releasing an analysis soon. Read the full CMS announcement, LeadingAge’s press statement, and the Federal Register final rule.

Check out the LeadingAge Ohio Education Calendar!

LeadingAge Ohio holds valuable education webinars and in-person events throughout the year. Opportunities are added weekly. See the complete Schedule of Events.