The Senate Finance Committee adopted a substitute version of HB96 (Stewart), the FY26-27 state operating budget, on Tuesday that would reduce the Medicaid State GRF line by 1 percent in FY26 and 1.5 percent in FY27. The Senate sub bill maintains the "trigger" language from the executive and House versions that would terminate Medicaid expansion coverage should the federal government drop the matching funds rate below 90 percent.
The bill retains the governor-proposed transition to a PDPM case mix over three years, relying only on the nursing component, and even more problematically does not include language which would make up for the difference between RUGS and case mix scores. Ohio’s current statewide average RUGS score is 3.029, while its average statewide PDPM is 1.454, representing a nearly twofold difference. Without this adjustment, Ohio providers would see a statewide average 50% cut to the direct care portion of the rate. (Related: See Maximize Your Membership under LeadingAge Ohio news for a free PDPM analysis)
Members are encouraged to reach out to their state senator today to let them know how damaging this “de facto” cut would be to Ohio nursing homes. LeadingAge Ohio has drafted the following language, which members can tailor to their own circumstances:
Dear Senator LAST NAME,
My name is NAME and I am TITLE at ORGANIZATION. I am writing to you to share an urgent concern we feel needs to be addressed in the state operating budget before it completes the legislative process, and ask that you support a budget neutral technical amendment that has been submitted for the omnibus that will correct the issue.
As you know, nursing homes that have residents with more complex or higher-acuity care needs require more nurses, aides and therapists. To account for this, the direct care portion of the reimbursement system is adjusted by a case mix index (CMI) derived from resident assessment data. The Centers for Medicare & Medicaid Services (CMS) is transitioning from an old system to the new system, called the Patient-Driven Payment Model (PDPM). House Bill 96 specifies that Ohio’s SNFs will begin to change from RUGs to PDPM July 1 of this year.
When the Ohio Department of Medicaid crafted the language for this transition for inclusion in the executive version House Bill 96, the Department omitted a critical piece of the transition. While each system’s case mix scores range from scores of roughly 1.0 to 4.35, the current average RUGS score is significantly higher than the average PDPM score– by about twofold. This means that, without adjustment, many Ohio nursing homes will take a severe reimbursement cut based on this system change. In concrete terms, many nursing homes across the state will receive an average cut of $70 per day if the Senate bill remains unchanged.
Our technical amendment will create an adjustment factor between RUGS and PDPM to maintain budget neutrality.
We ask for your help in supporting this omnibus amendment, and we would love to discuss with you further at your convenience.
Thank you,
NAME
On the positive side, the Senate-version of the bill restores the Ohio Housing Trust Fund to a statewide pooled fund, and removes the House-added cap of 15,000 for private rooms, and reverts to current law of a $160 million annual cap.
Another top concern is the elimination of two PACE amendments dealing with expansion and timely enrollment, which though cost-saving, may have been misinterpreted as an expansion of the Medicaid program. LeadingAge Ohio plans to testify this Thursday to focus on these most-urgent issues, encouraging the Senate Finance Committee to include changes in their omnibus amendment. Amendments are due this Friday, June 6 at noon.
For the complete breakdown of the Senate’s substitute version of the bill, see LeadingAge Ohio’s budget alert.
Questions regarding the bill may be directed to Eli Faes at efaes@leadingageohio.org or Susan Wallace at swallace@leadingageohio.org. As the budget reconciliation bill undergoes further changes during the U.S. Senate legislative process, LeadingAge continues to urge members to reach out to Senators Jon Husted and Bernie Moreno to share your concerns on Medicaid sections affecting state financing, provider reimbursement, and eligibility, including the moratorium on new or increased provider taxes and limiting retroactive coverage in Medicaid to one month (rather than the current three months) prior to an individual’s application date.
The bill represents the largest cut to the safety net program since its inception, and would hit Ohio particularly hard, given Ohio is a Medicaid expansion state and also relies on provider taxes to generate funds to Medicaid. The proposal includes a number of cost-shifting measures, like requiring a state share for SNAP, and will undoubtedly force Ohio into a budget corrections process no sooner than our state budget is finalized. State Senator Moreno very publicly avowed he would not support cuts to Medicaid, and Senator Husted is keenly aware of the impact this will have on Ohio, given his recent leadership on health issues as Lieutenant Governor.
Congress aims to have the budget reconciliation package to President Trump by July 4, 2025, so please act now.
Get the latest intelligence on the budget reconciliation process from LeadingAge’s policy staff by joining LeadingAge’s member-only National Policy Pulse call on Monday, June 9 at 3:30 PM ET. Sign up here. Top You Asked: Our nursing home is doing COVID-19 testing for new admissions on days 1, 3, and 5. Is this required?
We Answered: No, routine admission testing for COVID-19 is not required. Nursing homes are required to follow the QSO-20-39-NH memo, which refers providers to the CDC Infection Control Guidance. Under this guidance, admission testing is at the discretion of the facility.
LeadingAge Ohio reminds providers that any facility practice, such as testing new admissions, must be accurately reflected in the facility’s Infection Control policy. If a policy states that admission testing will occur, but the facility does not follow it, this inconsistency could result in a citation. Always ensure that practices and policies are aligned and updated as facility operation changes occur. Top The Ohio Senate’s proposed revisions to House Bill 96 retain the Governor’s plan to transition Medicaid reimbursement to the Patient-Driven Payment Model (PDPM) over three years, using only the nursing component for case mix. However, the current bill language does not address the difference between existing RUGS scores and the new PDPM case mix scores—an omission that could have a significant financial impact on many providers.
To help members navigate this transition, LeadingAge Ohio is offering a complimentary, customized PDPM analysis report through our valued Partner Squared Business Solutions. This report provides a detailed look at your organization’s Medicaid assessment data under PDPM, including case mix-driven financial projections and peer comparisons, to help you understand how your organization may be affected.
To request your free report, contact Stephanie Christopher at schristopher@squaredbusinesssolutions.com. Now is the time to get ahead of the curve and ensure you’re prepared for the changes ahead! LeadingAge Ohio is proud to welcome guest speaker Alice Bonner, PhD, RN, FAAN, FAANP, to the upcoming June Activity Professionals Network meeting. A nationally recognized expert in nursing home quality and aging services, Dr. Bonner will share insights on strengthening resident councils and the impactful work of the Institute for Healthcare Improvement (IHI).
Resident councils are a vital tool for promoting autonomy, engagement, and dignity among nursing home residents. Strengthening these councils supports a culture of person-centered care, ensures resident voices are heard, and enhances overall quality of life in long-term care communities.
Dr. Bonner brings over three decades of experience as a nurse practitioner and a distinguished leadership career in both federal and state aging policy. She currently serves as Senior Advisor for Aging at IHI, Chair of the Moving Forward Nursing Home Quality Coalition, and Adjunct Faculty at Johns Hopkins University School of Nursing. Her extensive background includes leadership roles at CMS and the Commonwealth of Massachusetts, with a research focus on community-based care, nursing workforce, and nursing home improvement.
Networks are free to LeadingAge Ohio members, but registration is required. Don’t miss this opportunity to engage with a leader in the field and explore strategies to elevate the resident voice in your community.
Please share this registration information with the activity professionals in your organization! June 26 | 10:00AM–2:00PM | LeadingAge Ohio Office, Columbus
Artificial intelligence is no longer a future concept—it’s already reshaping how nonprofits approach fundraising, storytelling, and donor engagement. On June 26, LeadingAge Ohio invites development and philanthropy professionals to gather in person for a working session that brings AI out of the headlines and into the hands of those serving aging communities.
This isn't a lecture—it's a lab. Attendees will bring laptops, roll up their sleeves, and work in real time with tools like ChatGPT. Breakout groups will dive into sample prompts and nonprofit scenarios pulled directly from the aging services world, offering a chance to explore how AI might lighten workloads, sharpen messaging, or help teams think differently about the challenges they face.
Seating is limited! Register today! August 26-28, 2025 | Hilton Columbus Easton
Are you ready to be inspired, challenged, and equipped to lead meaningful change?
LeadingAge Ohio proudly presents its 2025 Annual Conference and Trade Show, themed “Ripples of Impact”—a powerful reflection of how each action we take, no matter how small, can create lasting change in the lives of older adults, in our communities, and within our organizations.
This dynamic, three-day event offers:
- Timely, interdisciplinary education sessions on the most pressing issues in aging services, from workforce innovation to regulatory updates, health equity, quality improvement, leadership development, and more.
- Game-changing keynote speakers and thought leaders who will inspire you to think big and act boldly.
- Valuable networking opportunities with peers, providers, and partners from across Ohio and beyond—because some of the best ideas come from meaningful conversations.
- A vibrant tradeshow floor showcasing the latest tools, technologies, and solutions to help you thrive in an ever-evolving care landscape.
Bring your team for a front-row seat to the future of aging services. Every session attended, idea shared, and connection made has the power to create ripples of impact—both within your organization and across the continuum of care.
Don’t miss this opportunity to recharge your mission, reimagine your strategies, and reaffirm your commitment to those you serve.
Stay tuned for registration details and the full agenda—coming next week at LAOConference.org. There's always something happening at LeadingAge Ohio, and we don’t want you to miss a moment. From educational opportunities to networking events, our calendar is packed with ways for members to stay informed, engaged, and connected.
Explore what's ahead and make plans to join us—whether you're looking to expand your knowledge, connect with peers, or get involved in shaping the future of aging services in Ohio.
View all upcoming events here and mark your calendar today!
Top LeadingAge is excited to once again offer the popular Shared Learning Series: Embracing Dementia Inclusion series, designed to jumpstart dementia-inclusion journeys through education, guidance, resources, and peer support. Register by September 15 for this five-part series open to 36 LeadingAge provider-member participants. The live, virtual sessions begin in late September and last into late October. Registration is first-come, first-served, so claim your spot today. CMS’s off-cycle revalidation process for skilled nursing facilities continues to evolve, with new guidance and clarifications emerging. Join LeadingAge on July 1 to hear the latest updates ahead of the August 1 submission deadline. Presented by Mark Mattioli from LeadingAge partner Post & Schell, P.C., you’ll hear an overview of the statutory and regulatory framework behind this requirement; a brief review of new guidance and clarifications on reporting additional disclosable parties, board members, real property ownership, and government authorities; and participate in an extended Q&A, giving you the opportunity for practical advice in real time. Don’t miss this event! Register now on the LeadingAge Learning Hub. Top All nursing home members that applied for– and were approved for– private room payments will be required to have a policy in place prioritizing placement in private rooms no later than July 1, 2025. Additionally, they must participate in the resident / family surveys conducted by the Office of the State Long-term Care Ombudsman in partnership with Scripps Gerontology and Vital Research.
The requirement was outlined in HB 133, codified in ORC 5165.158:
5) Beginning July 1, 2025, to retain eligibility for private room rates, a nursing facility must do both of the following:
(a) Have a policy in place to prioritize placement in a private room based on the medical and psychosocial needs of the resident;
(b) Participate in the resident or family satisfaction survey performed pursuant to section 173.47 of the Revised Code.
LeadingAge Ohio is developing a sample private room policy and will include it in next week’s edition of The Source. Questions regarding this requirement may be directed to Stephanie DeWees at sdewees@leadingageohio.org. Top A recent analysis highlights a looming workforce crisis in the long-term care sector, projecting a need for an additional 660,000 workers nationally by 2033 to meet the growing demand for services. While employment in assisted living and home health has rebounded and even surpassed pre-2020 levels, skilled nursing facilities and continuing care retirement communities have not fully recovered, experiencing declines of 4% and 5% respectively. The study underscores that core healthcare roles—such as registered nurses, licensed practical nurses, and licensed vocational nurses—constitute the majority of positions in these settings, with skilled nursing facilities having the highest concentration. The findings suggest that addressing this workforce gap will require strategic planning and investment across all long-term care sectors.
Read the full article here. The Department of Health and Human Services (HHS) is appealing a federal court decision that invalidated key components of the national nursing home staffing mandate. In April, U.S. District Judge Matthew J. Kacsmaryk ruled that the Centers for Medicare & Medicaid Services (CMS) exceeded its authority by requiring 24/7 registered nurse coverage and setting minimum hourly staffing rates. HHS has now filed an appeal with the Fifth Circuit Court of Appeals, seeking to reinstate these provisions. The outcome of the appeal could significantly influence future staffing regulations and operational standards for nursing homes nationwide.
Read the full article here.
Keep up to date on this issue with LeadingAge’s staffing serial post here. On June 4, the nonpartisan Congressional Budget Office (CBO) released an updated fiscal analysis of the House-passed One Big Beautiful Bill Act (OBBB). The revised score reflects new amendments and clarifies the financial and coverage implications of the legislation as passed on May 22.
According to the CBO, an estimated 16 million individuals are expected to lose health insurance coverage if the bill is enacted:
- 10.9 million will lose coverage directly due to the bill's provisions, including nearly 8 million losing Medicaid and the rest losing ACA Marketplace coverage.
- An additional 5.1 million will lose coverage due to related administrative changes: namely, the codification of the Trump-era Marketplace rule and the expiration of enhanced premium tax credits at the end of 2025, which are not extended in the legislation.
In total, these combined changes would leave 16 million people without coverage.
Driving much of the impact are accelerated timelines for implementing Medicaid work requirements and increased eligibility redeterminations—amendments made just before House passage. These changes, CBO notes, contribute to significantly higher projected federal savings.
The updated analysis forecasts $1 trillion in cuts to federal healthcare spending over the next decade, including more than $800 billion in Medicaid funding reductions.
As LeadingAge continues to monitor the legislative process, we will provide members with updates on how these changes could impact older adults, long-term care providers, and the broader healthcare landscape in Ohio.
The full CBO score can be accessed here.
Top During a recent Director of Nursing (DON) networking call, participants shared practices and insights around ensuring informed consent for psychotropic medications—and whether similar processes are used for other medications. The discussion was timely with the updated CMS guidance outlined in the revised QSO-25-14-NH memo, which states:
In accordance with the requirements at §483.10(c), residents have the right to be informed of and participate in their treatment. Prior to initiating or increasing a medication, the resident, family, and/or resident representative must be informed of the benefits, risks, and alternatives for the medication, in advance of such initiation or increase. The resident has the right to accept or decline the initiation or increase of a medication. To demonstrate compliance, the resident’s medical record must include documentation that the resident or resident representative was informed in advance of the risks and benefits of the proposed care, the treatment alternatives or other options and was able to choose the option he or she preferred. A written consent form may serve as evidence of a resident’s consent to medication, but other types of documentation are also acceptable. If a medication has been initiated or increased, and there is not documentation demonstrating compliance with the resident’s right to be informed and participate in their treatment, noncompliance with §483.10(c) exists and F552 must be cited.
One best practice shared during the networking call was the use of drug class–specific consent forms. These include preprinted information on benefits and side effects, along with documentation of the diagnosis, prescribed dosage, and any interventions that failed prior to medication use.
For more information on navigating the revised QSO-25-14- NH memo, view this LeadingAge Ohio article regarding the resident’s right to be informed. This survey tip, along with other survey tips, can be accessed on the LeadingAge Ohio webpage under the Communications tab, then The Source tab. CMS has also updated the survey resources on the CMS Nursing Home webpage in accordance with the revised QSO-25-14- NH memo.
DONs interested in joining future networking calls can email Stephanie DeWees at sdewees@leadingageohio.org.
LeadingAge Ohio encourages facilities to monitor compliance using the surveyor guidance found in the State Operations Manual Appendix PP . Additionally, the survey pathways can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. LeadingAge has developed webinars and resources on the requirements of participation which are located on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups. Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.
For more information about the requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the June 11 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org. The Centers for Medicare & Medicaid Services (CMS) has announced its FY 2026 performance budget, outlining the expanded Quality Improvement Organization (QIO) program through the 13th Scope of Work (SoW). Under the 13th SoW, the QIO program is broadening its focus from infection control alone to include several quality-of-care deficiencies that have the potential to cause more than minimal harm. The F-tags specifically targeted under this initiative include:
Resident Assessment and Care Planning:
- F660: Comprehensive Care Plans
- F661: Discharge Planning
Quality of Life and Care:
- F697: Pain Management
- F698: Dialysis Care
- F741: Sufficient and Competent Staff
- F743: Sufficient and Competent Staff for Behavioral Health
Nursing and Physician Services:
- F710: Resident Needs for Nursing, Physician, and Specialized Rehab Services
Pharmacy Services:
Administration:
- F867: QAPI Program Implementation
Infection Control:
- F880: Infection Prevention and Control
- F883: COVID-19 Vaccination of Facility Staff
For FY 2026, CMS aims to reduce the percentage of nursing homes with these cited deficiencies (at severity level D or higher) from a projected baseline of 56% in FY 2025 to 50.4% by January 2027. This means that survey deficiencies in these areas will be a particular focus for QIN-QIO technical assistance and ongoing survey oversight.
In practice, this approach will include an initial period where QIN-QIOs assess existing quality improvement efforts across states and facilities. Following this phase, nursing homes may see more targeted technical assistance aligned with these F-tags, depending on regional findings.
CMS has framed these efforts as part of a larger strategy to improve resident safety, quality of life, and care coordination across the long-term care sector. LeadingAge Ohio is supporting its membership through the Survey Collaborative, monthly Survey Tips and Tactics calls, and weekly newsletter survey tips. Sign up for upcoming offerings on the Learning Center. The Centers for Medicare & Medicaid Services (CMS) has released the draft Minimum Data Set (MDS) 3.0 Item Sets version 1.20.1v3-Section_R_removed, reflecting proposed changes in the FY 2026 Skilled Nursing Facility Prospective Payment System (SNF PPS) rule (90 FR 18590). These updates directly align with the proposed revisions to the SNF Quality Reporting Program (QRP).
Key Changes Include:
- The draft version v1.20.1v3 removes items R0310, R0320, and R0330 and replaces item R0340 with A1255.
- These revisions correspond to CMS’s proposed removal of four standardized patient assessment data elements under the Social Determinants of Health (SDOH) category:
- Living Situation (R0310)
- Food (R0320A and R0320B)
- Utilities (R0330)
Originally, these MDS data elements were scheduled for required reporting for residents admitted between October 1 and December 31, 2025 (for FY 2027 QRP compliance). However, CMS now proposes that these items will not be required starting with the FY 2027 SNF QRP. This proposal aims to reduce provider burden and align future data collection with the increasing interoperability of health information technology systems.
The final MDS Item Sets will take effect on October 1, 2025. The final MDS Item Sets will be either this draft v3 which does not include items R0310, R0320, and R0330 and replaces item R0340 with item A1255 or the previously posted 1.20.1v2. The FINAL MDS Item Sets v1.20.1 will be posted in late summer, depending on the decisions finalized in rulemaking.
For more details, including access to the draft MDS 3.0 Item Sets v1.20.1v3-Section_R_removed and the Item Matrix v1.20.1v3-Section_R_removed, visit the Downloads section on the MDS 3.0 Resident Assessment Instrument (RAI) Manual webpage. The Centers for Medicare & Medicaid Services (CMS) has resumed regular stakeholder calls with LeadingAge and other associations after a pause tied to a federal communications freeze. Now held quarterly, these calls provide updates and clarification on key policy issues.
During the May 27 call, CMS confirmed the Nursing Home Staffing Campaign is moving forward, including financial incentives for RNs. They also clarified that CMS Regional Offices remain open despite broader HHS field office closures.
CMS provided updates on state transitions to iQIES, which are expected to be complete by July 14, and confirmed that the Civil Money Penalty Reinvestment Program (CMPRP) has resumed. Providers may now submit grant requests to their state contacts.
LeadingAge will continue to monitor developments and share updates with members as available. This page provides information on upcoming calls and allows you to subscribe to email updates on various CMS topics. By signing up, you'll receive notifications about future stakeholder calls and other relevant CMS events. Top LeadingAge Ohio is proud to welcome two exceptional organizations to our community of nonprofit aging services providers: Lima Convalescent Home in Lima, Ohio, and Saint Therese at St. Mary of the Woods in Avon.
Lima Convalescent Home has served the Lima area since 1958 as the region’s first nursing home. Today, it continues its nonprofit mission with a 56-bed skilled nursing facility, offering compassionate care to older adults and individuals with chronic conditions. The campus includes a specialized Memory Care Unit, an acclaimed Rehab Wing, and a dedicated Therapy Department.
The home’s commitment to person-centered care is reflected in its two six-bed Green House residences—known as The Greens—and Lochhaven Assisted Living, all part of a unified campus. Recent renovations to the Legacy Building added a cozy hearth room, full kitchen, and additional private spaces, blending modern comfort with the familiarity of home. Learn more here.
On the other side of the state, Saint Therese at St. Mary of the Woods brings a deep commitment to compassionate, faith-based care in Avon. Their beautiful campus offers a vibrant Independent Living neighborhood with thoughtfully designed apartments, full kitchens, wellness programming, and spiritual support. With Assisted Living and Skilled Nursing also available, Saint Therese ensures a seamless and supportive experience through every stage of care.
To experience their warm, welcoming community, don’t miss Friendsgiving in June, a midyear celebration with classic Thanksgiving-style dinner, live music, guided tours, and great company—happening Thursday, June 19 from 5–7 PM at 35755 Detroit Road in Avon. RSVP by June 12 here.
Together, Lima Convalescent Home and Saint Therese at St. Mary of the Woods represent the heart of LeadingAge Ohio’s mission—delivering dignity, connection, and quality care every day.
Help us welcome Lime Convalescent and St. Mary of the Woods on LinkedIn! 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
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