Last week, LeadingAge Ohio provided an update on predictions on Mandamus payouts. Since then, the Ohio Department of Medicaid has made changes to its calculation methodology that will further delay payments from this week to possibly as early as next week.
LeadingAge Ohio and the other nursing facility associations recently reviewed preliminary provider-level estimates provided by the Ohio Department of Medicaid (ODM). However, an issue has now been identified involving managed care claims data from one of the health plans. This plan did not provide the claim-level detail necessary for ODM to incorporate those days into the claims-based calculation.
As a result, ODM has changed its calculation methodology. Rather than relying solely on claims-based days, the Department is looking to Medicaid cost report data—particularly the days reported on those cost reports—to calculate payments.
The change in methodology has resulted in changes to the preliminary estimates. For most providers, the difference from the earlier estimate is expected to be less than 10%. However, some providers are seeing significantly larger changes. In particular, providers with higher levels of PA1, PA2 or ventilator days may see substantial decreases from their earlier estimates, while other providers may see increases. Additional changes may be necessary as ODM determines how to account for dates not yet reflected in Medicaid cost report data.
It is important to note that the preliminary estimates shared previously were not final payment amounts. The calculations have continued to be reviewed and refined as ODM works to ensure that the appropriate data is incorporated.
ODM had anticipated issuing provider communications earlier this week and beginning the first round of payments on Friday. The change in methodology and resulting recalculations have delayed that timeline, with communications and payments possible as early as next week.
LeadingAge Ohio continues to stay in close contact with ODM and the other nursing facility associations as the Department works through the final calculations and payment process. We understand the frustration that another delay creates, particularly after the lengthy process leading to this point. We will continue to share information with members as soon as we have confirmed updates.
Providers should watch for communication from ODM through the Provider Network Module (PNM) system. Top You Asked: Where can I find my 1700 PBJ reports in iQIES?
We Answered: When CMS transitioned PBJ reports from the Certification and Survey Provider Enhanced Reporting (CASPER) system to the Internet Quality Improvement & Evaluation System (iQIES), the 1700 report numbers were removed from the report names. The reports are still available in iQIES, but facilities will need to look for them by their new names.
For example, the former 1700D Employee Report in CASPER is now called the PBJ Employee Report in iQIES. CMS provides a crosswalk of the former CASPER report names and their corresponding iQIES report names in the revised QSO-26-12-NH memo.
For assistance with accessing, running, or downloading the PBJ reports, refer to the CMS iQIES Reports User Manual. Top LeadingAge Ohio’s next Advocacy in Action on September 29 will provide a brief overview of S.B. 315, the Ohio Medicaid Program Integrity and Fraud Prevention Act, which takes effect October 6.
The presentation will highlight key changes involving claims, provider enrollment, electronic visit verification (EVV), fraud detection, payment integrity, and prior authorization, along with practical steps providers can take as implementation gets underway.
Join us September 29 to learn what Medicaid providers should be watching as S.B. 315 takes effect. Stay informed and ahead of the curve with LeadingAge Ohio Shop Talks—monthly conversations focused on the latest developments impacting your sector. Hear timely updates and insights from national and state policy experts on what’s happening in your sector, what’s on the horizon, and what it means for your organization. Each Shop Talk also includes dedicated time for Q&A and member discussion.
Sign up for a Shop Talk:
- Shop Talk: Long-Term Care - Nursing Facilities & Assisted Living (occurs the first Tuesday of every month at 11:30 a.m.)
- Next webinar: October 6, 2026 at 11:30 a.m.
- Agenda: Orientation – what is Shop Talk? • Federal update from LA National • Mandamus update/discussion • Rules updates: Behavioral Health and NF Vent program • S-AGE goes live
- Shop Talk: Home Health & Hospice (occurs the second Tuesday of every month at 11:30 a.m.)
- Next webinar: October 13, 2026 at 11:30 a.m.
- Agenda: Orientation – what is Shop Talk? • Federal update from LA National • Mandamus update/discussion • HB945 deep dive
- Shop Talk: Affordable Senior Housing (occurs the third Tuesday of every month at 11:30 a.m.)
- Next Webinar: October 20, 2026 at 11:30 a.m.
- Agenda: Orientation – what is Shop Talk? • Federal update from LA National
REMINDER: Our monthly Advocacy in Action will also be moving to this time slot, starting on September 29, 2026 (occurs the fourth Tuesday of every month at 11:30 a.m.). LeadingAge Ohio is compiling a list of member organizations with event and meeting spaces available to host future LeadingAge Ohio events.
We’re interested in spaces that could accommodate a variety of gatherings, including board meetings, Leadership Academy sessions, committee meetings, educational programs, and awards ceremonies.
If your organization has a meeting or event space you’d be willing to make available, please share the details with us. We’d love to keep your organization in mind as we plan future events across Ohio.
Have a space to share? Let us know here. Questions can be directed to Molly Homan at mhoman@leadingageohio.org. The LeadingAge Ohio Political Action Committee (PAC) invites members, partners, and guests to spend Monday, September 28, 2026, at the Golf Club of Dublin for a day on the green that makes a difference.
More than just a round of golf, the annual PAC Outing combines spirited competition, camaraderie, and the chance to connect with colleagues and partners, all while enjoying a beautiful course setting. Every swing supports LeadingAge Ohio’s advocacy, ensuring older Ohioans and the professionals who serve them have a strong voice at the statehouse.
Registration opens at 9 a.m. with a 10 a.m. shotgun start. Both foursomes and individual golfers are welcome, and spots are available through Friday, September 25. Sponsorships are also open for those who want to further champion the PAC’s mission.
View full event details and register. For questions regarding sponsorship, please contact Corey Markham, Director of Education and Business Development, at cmarkham@leadingageohio.org.
Please note that contributions to Political Action Committees must be made by individuals, partnerships, or LLCs, not corporations, and are not tax-deductible. All contributions are voluntary and will not influence membership standing or benefits. Enrollment is now open for the Winter 2027 session of the Core of Knowledge, a program designed for Administrators-in-Residence that fulfills the academic requirement set by the Board of Executives of Long-Term Services and Supports (BELTSS) for qualifying to sit for the state licensure board examination to become a Licensed Nursing Home Administrator (LNHA).
The three-week course will be held January 11–28, 2027, Monday through Thursday, at the OCLC Conference Center. This is one of only two opportunities to complete the required coursework in 2027.
The deadline to register is December 11, 2025. Learn more and register for the 2027 Winter Core of Knowledge. For additional information, contact Corey Markham at cmarkham@leadingageohio.org. Top How are Continuing Care at Home (CCaH) programs evolving, and what do today's trends mean for long-term sustainability? LeadingAge’s latest on-demand resource features experts from Continuing Care Actuaries sharing updates on the evolving CCaH actuarial model, along with insights into industry demand, risk considerations, and long-term program sustainability. Free access for LeadingAge members. As more older adults live with cognitive change, aging services organizations have reason to consider what a more inclusive approach to dementia support could look like. Whether you are just beginning to explore dementia inclusion or building on existing efforts, LeadingAge’s three-part live event, "A Practical Introduction to Dementia Inclusion," will offer practical insights and inspiration to help advance this work in your organization. Top With Ohio’s Nov. 3 general election approaching, aging services providers can help older adults access reliable information about registering and making a plan to vote. The voter registration deadline is Oct. 5, with absentee voting by mail and early in-person voting beginning Oct. 6. Providers can direct residents, clients and other people they serve to the Ohio Secretary of State’s voting resources for information on registration, absentee voting, early voting, Election Day voting and county boards of elections.
Providers may also want to share information about accessible voting options with people who need additional assistance. Ohio offers options including accessible absentee ballots, curbside voting and procedures for voters who cannot travel to a polling location because of illness, disability or confinement. Disability Rights Ohio’s voting resources provide another statewide resource for voting rights and accessibility questions, including an Election Day voter hotline. A recent review by the Ohio Auditor of State’s Office found that some Ohioans who did not meet eligibility requirements continued to receive Medicaid benefits.
The interim review examined a sample of 1,500 individuals enrolled in Medicaid programs for the Aged, Blind and Disabled (ABD) population. Of those sampled, 49 individuals—3%—were determined to be ineligible, including 25 who exceeded allowable resource limits. The review found that $356,541 in benefits had been paid on behalf of those individuals. Three had more than $1 million in available resources.
The review also found that 3,172 individuals who had died remained enrolled in ABD-related programs, resulting in nearly $1.8 million in benefits paid on their behalf.
According to the Auditor’s Office, some of the issues were attributed to infrequent eligibility reviews, outdated application versions and the use of ex parte renewals. The office plans to continue reviewing the remaining ABD population to determine the full scope of eligibility concerns.
Read the full release and interim report from the Ohio Auditor of State. A new bill introduced in the Ohio House could address the gap in Medicaid’s Personal Needs Allowance (PNA) for assisted living residents.
House Bill 1008, introduced September 14, would amend Ohio law regarding the Medicaid PNA for individuals receiving services through the Medicaid-funded assisted living program.
LeadingAge Ohio has been advocating for a solution since the state’s 2025 budget increased the PNA but did not extend the increase to residents receiving Medicaid-funded assisted living services. LeadingAge Ohio encouraged members to ask residents and their families to contact state leaders about the issue and share why additional personal-needs funds matter.
The issue remains one of equitable treatment across Medicaid-funded long-term care settings. LeadingAge Ohio continues to support ensuring that assisted living residents are not left behind as the state addresses the PNA.
LeadingAge Ohio will review and monitor the legislation and advocate for a solution that provides assisted living residents with the same opportunity to retain additional funds for personal needs.
Read more on McKnight’s Senior Living. Top Supporting employees’ growth and helping them build skills is critical to retention. As part of National Workforce Development Month (NWDM) observance, members can access the LeadingAge-curated resources, insights, and programs below:
Apprenticeship programs: A proven way to grow the workforce, LeadingAge’s step-by-step guide outlines the basic steps to get started on creating a registered apprenticeship program to advance your team members’ skills.
Insights on creating a tech-savvy workforce: As artificial intelligence (AI), automation, and data are increasingly embedded in aging services operations, employers must ensure staff have the confidence, judgment, and skills to succeed in a technology-driven workplace. LeadingAge members Asbury Communities, Sun Health, Vivie, United Methodist Communities, and Ingleside share tips and strategies.
Leadership development: Recruiting leaders is difficult. Developing them is essential. Over the last three years, LeadingAge’s Next Level Leadership Series has supported more than 200 LeadingAge members in developing their leadership skills. Starting October 20, the series combines expert guidance, peer-to-peer learning, and real-world application to help participants strengthen their leadership presence and contribute at a higher level. Take action now, during NWDM, and register for the Fall series. Join more than 1000 of your LeadingAge peers for our National Policy Pulse calls where the LeadingAge policy and advocacy team keeps members equipped to navigate the changing landscape of aging services national policy. The calls are on Mondays at 3:30 p.m.. If you’re interested in signing up for these members-only calls, please sign up using the link on our National Policy Pulse webpage. Top The Centers for Disease Control and Prevention (CDC) updated its Infection Control in Healthcare Personnel guidance on September 11, 2026, including recommendations for managing healthcare personnel (HCP) who are exposed to or infected with viral respiratory infections. Nursing homes should review their current employee illness and return-to-work policies and update them as necessary to reflect the new recommendations. The updated guidance provides a more unified approach to respiratory viruses, including SARS-CoV-2, influenza, respiratory syncytial virus (RSV), parainfluenza, rhinovirus, human metapneumovirus and others.
For asymptomatic HCP with a known or suspected exposure:
- Work restrictions are not necessary.
- HCP should wear source control from the day of first exposure through at least the fifth day after the last exposure.
- HCP should monitor for signs or symptoms of a viral respiratory infection for at least five days following their last exposure.
- If symptoms develop, the HCP should be restricted from work according to the criteria for suspected or confirmed infection.
For HCP with a suspected or confirmed viral respiratory infection, restrict from work until:
- At least three days have passed from symptom onset (or from the first positive respiratory virus test if the individual remains asymptomatic); AND
- The HCP has been fever-free for at least 24 hours without the use of fever-reducing medications; AND
- Symptoms are improving; AND
- The HCP feels well enough to return to work.
The day of symptom onset is considered day 0, making day 4 the earliest possible return-to-work day when all other criteria are met. Upon return, HCP should wear source control through at least the end of day 7, making day 8 the first possible day to work without source control.
Facilities should review the return-to-work policies and how exposure is defined. Educate staff on the updates to the policies, who they should notify of exposures and symptoms, and source control protocols. The Centers for Medicare & Medicaid Services has resumed the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for skilled nursing facilities. CMS announced the report’s return in its Sept. 17 Medicare Learning Network newsletter, part of the agency’s broader restart of PEPPER reports for providers throughout 2026.
PEPPER gives skilled nursing providers access to billing data that can help identify claims that may warrant closer review, monitor payment patterns and track trends such as patient length of stay. Providers can access their reports through the PEPPER Portal. Additional information, including the User Guide and details about an upcoming webinar, is available through PEPPER Training & Resources. Top LeadingAge Ohio welcomes Saint Therese of Westlake to our membership. Formerly known as The Belvedere of Westlake, the 33-apartment assisted living and memory care community has served the Westlake area since opening in 2000. In 2025, it became part of Saint Therese, bringing the longstanding community into a mission-driven organization with a Catholic heritage and nearly six decades of service. Saint Therese has retained the community’s assisted living and memory care focus while connecting residents with a broader continuum of services through its nearby sister community, St. Mary of the Woods in Avon.
Welcome Saint Therese of Westlake to the LeadingAge Ohio community!
Learn more about Saint Therese of Westlake. LeadingAge Ohio member United Church Homes has been certified as a Great Place to Work by Great Place to Work Institute and Activated Insights. The recognition is based on a survey of employees across United Church Homes’ locations in 15 states, examining more than 60 aspects of the employee experience, including pride in the organization’s community impact, the meaning employees find in their work and their confidence that their work makes a difference.
United Church Homes President and CEO Kenneth Young said the recognition is especially meaningful because it reflects employees’ own experiences. For more than 110 years, the nonprofit, faith-inspired organization has served older adults through housing and services rooted in its mission and values. Read the full announcement from United Church Homes. Top CMS has released the FY 2027 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule, delivering a modest Medicare payment increase while continuing the agency's long-term focus on quality reporting, data accuracy, and documentation integrity. While most operational changes are phased in over the next several years, the rule outlines several important updates that providers should begin tracking now. Click here to learn more.
Information provided by TMC, a trusted vendor from the Value First portfolio. Value First is a LeadingAge member benefit that focuses on the needs of senior living communities by providing choices, solutions, and savings on food, medical, environmental, office supplies, and capital equipment. 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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