Tune in on Thursday, January 22 at 10am for the January 2026 edition of Advocacy in Action. The LeadingAge Ohio policy team will be joined by Georgia Goodman with LeadingAge National for an overview and discussion of HR1, CMS’s November guidance memo to states, and whether CMS will require states to begin trimming their Medicaid spending earlier than expected.
Register here to join. Nursing home members across the state continue to wait on their rate packages for 1/1/2026 in anticipation of February billing. The rates, published every January and July 1, are typically released either the final week of the month or the first week of the effective month, though delays have occurred in the past.
LeadingAge Ohio is particularly focusing on Ohio’s private room payments, for which FY 2026 is the first complete year in which the rooms will be billed. The pool for these funds is limited, and when it is exhausted during a fiscal year, payments will cease until the beginning of the next fiscal year. Due to the mandamus action, Medicaid has not previously shared the “burn rate” for the private room payments, which would allow nursing homes to anticipate when the pool of funding is exhausted.
LeadingAge Ohio will continue to monitor this issue, hopeful that we will see the packages published in the coming days. Questions may be directed to Susan Wallace at swallace@leadingageohio.org. Top You Asked: Can Certified Nursing Assistants (CNA) documentation be used to validate Section GG coding during an MDS exception review?
We Answered: The Ohio Department of Medicaid has provided a Section GG Functional Performance Fact Sheet that addresses supporting documentation. ODM states the following about direct care staff and qualified clinician documentation.
The requirements for Section GG come with significant changes for the Activities of Daily Living (ADLs) and tracking for functional or reporting purposes. The previously utilized ADL flow sheets completed by the Certified Nursing Assistants (CNAs) will no longer be functional to align with Section GG. If CNAs are going to do the data collection of Section GG there will need to be training. Direct care staff must understand each task definition and the performance scale. The Resident Assessment Instrument (RAI) user’s manual defines each activity and sets forth the steps for completing the assessment.
Please note: Direct care staff will not determine “usual” performance. Direct care staff documents actual performance during the episode/shift and qualified clinician will determine “usual” performance after reviewing documentation from the 3-day performance period. Top What should boards focus on to lead organizations successfully into the future? Lynn Daly, executive vice president at HJ Sims, joins host Susan Wallace on LeadingAge Ohio’s podcast, …Another Word for Living, for a thoughtful conversation on governance and organizational leadership. Daly breaks down key leadership trends, the do’s and don’ts of strong, effective boards, and the resources board members should understand before stepping into their roles.
Listen here or on any major podcast platform. Groundwork Ohio will be joining LeadingAge Ohio for the year's first All Member Call on January 21st at 10:00 AM to explore Ohio's Child Care Cred program, a brand‑new initiative designed to lower child‑care costs for working Ohio families. Under the program, participating families, their employers, and the state all share responsibility for child‑care expenses: employees pay 40%, employers contribute 40%, and the state covers the remaining 20%.
Groundwork Ohio will review who qualifies, how employers can participate, and what this means for providers, parents, and the broader aging services workforce. Don’t miss your chance to get up to speed and see how Child Care Cred might benefit your organization and the families you serve.
Register for the All Member Call on the LeadingAge Ohio Learning Center. LeadingAge Ohio welcomes members and partners to submit proposals for the 2026 Annual Conference and Trade Show, August 25–27, at the Hilton Columbus at Easton. This year’s conference celebrates Changemakers—leaders and teams advancing aging services through new ideas, tested approaches, and collaborative practice.
Proposals across all topic areas are welcome, with particular interest in home health and hospice, clinical practice and quality, reimbursement, marketing and communications, philanthropy, leadership development, technology, artificial intelligence, and workforce issues. Sessions should offer clear applicability for provider settings and avoid promotion of proprietary products.
The submission deadline is Monday, January 26, 2026. Full details and the application portal are available on the Call for Presentations page.
Questions may be directed to Corey Markham, Director of Education and Business Development, at CMarkham@leadingageohio.org. The Philanthropy Network invites organization leadership and development and finance professionals to join Paul Yeghiayan, CFRE, for a virtual presentation on how the new tax law will reshape the philanthropic landscape. With most provisions taking effect January 1, 2026, this session will help nonprofit leaders understand what’s changing, how it may influence donor behavior, and why it’s critical to engage donors now. Paul will unpack key impacts for high-net-worth and everyday donors and offer strategic guidance you can use today to support your fundraising success in the year ahead.
This presentation will take place January 29 at 10 a.m. Members may join here. LeadingAge Ohio members are encouraged to save the date for the Hondros College of Nursing Winter Career Fair on February 10 and 11 from 11:30 a.m. to 1 p.m. at the West Chester campus. This event offers an opportunity to connect with future nursing professionals and support recruitment efforts. Members are welcome to share the Winter Career Fair save-the-date poster within their organizations and networks.
As part of this partnership, members and their employees are eligible for discounted tuition at Hondros College of Nursing campuses across Ohio for Practical Nursing and Associate Degree in Nursing programs approved by the Ohio Board of Nursing. Members are encouraged to review and share the Hondros College of Nursing partner pricing flyer with staff and remind employees to mention their LeadingAge Ohio membership when requesting information. Top LeadingAge offers governance resources designed to help boards move beyond fiduciary oversight and take a more active role in organizational strategy, leadership alignment, and long-term sustainability. These tools support CEOs, leadership teams, and board members as they navigate increasing complexity across the aging services sector.
Members can access more than 20 self-guided governance resources through the LeadingAge Learning Hub, along with consulting services tailored to organizational needs. These materials are designed for use in board meetings, committee work, and strategic planning conversations to support stronger, future-focused governance. In a December 23 letter to Robert F. Kennedy Jr., LeadingAge called for the immediate revision of federal respiratory illness guidance and health care personnel return-to-work standards that have not been updated since 2023 and 2022, respectively. Although outdated, both sets of guidance continue to be enforced by the Centers for Medicare & Medicaid Services as infection control requirements, creating prolonged isolation periods for residents and operational challenges for providers, such as requiring residents to isolate for 10 to 20 days following COVID-19 infection, despite changes in the broader public health landscape.
LeadingAge urged Secretary Kennedy to restore the role of Centers for Disease Control and Prevention experts in updating the guidance, noting that revisions were underway before the Healthcare Infection Control Practices Advisory Committee was disbanded in spring 2025. Cybersecurity threats remain a daily reality for aging services providers, making preparation and continuous improvement essential. One foundational step is completing a HIPAA Security Rule risk analysis, a systematic review of where electronic protected health information is stored, how it flows through an organization, and where vulnerabilities exist. To support that work, the Office of the National Coordinator for Health Information Technology offers a free HIPAA Security Risk Assessment Tool.
LeadingAge members can also find additional cybersecurity education and resources through CAST to support informed planning and stronger resilience. Researchers from the LeadingAge LTSS Center @UMass Boston evaluated a major workforce initiative led by LeadingAge California aimed at addressing critical shortages among certified nursing assistants and home health aides. The three-year Gateway-In Project supported new entrants with paid training, wraparound supports, and job placement, helping reduce barriers to entering the field.
The evaluation found high employment and job satisfaction rates among graduates, with most working as CNAs or HHAs one year after training and many viewing the roles as a pathway to advanced careers in aging services. While participants reported strong preparation and program satisfaction, the findings also underscore ongoing challenges around wages and benefits that affect long-term retention.
Read more here. Top An Ohio appellate court has signaled caution for nursing homes that rely on stand-alone arbitration agreements signed by guardians without clear legal authority. In a recent decision, the Ninth District Court of Appeals upheld a trial court’s refusal to enforce an arbitration agreement signed by a resident’s guardian of person, concluding that such agreements are separate contracts and not automatically covered by authority to make care and placement decisions. The case, Barker v. Arbors at Stow, reinforces that arbitration provisions are evaluated independently from admission or resident care agreements.
The court found that while a guardian of person may consent to medical care and living arrangements, agreeing to arbitrate legal claims falls within the authority of a guardian of estate, who manages financial and legal matters. Because the resident’s guardian of estate did not sign the arbitration agreement, the court declined to enforce it. Legal counsel at Dinsmore & Shohl LLP note the decision highlights the importance of reviewing letters of guardianship—and powers of attorney—before executing arbitration or other binding legal agreements, particularly in skilled nursing settings where multiple fiduciaries may be involved. On January 1, 2026, the Centers for Medicare and Medicaid Services began to require prior authorization for certain services under traditional Medicare in Ohio and five other states. The change is part of a six-year federal demonstration focused on reducing fraud, waste, and clinically unsupported care.
The pilot - known as the Wasteful and Inappropriate Services Reduction (WISeR) Model - applies only to fee-for-service Medicare and does not affect Medicare Advantage plans.
What You Need To Know
- Seventeen Medicare-covered procedures now require prior authorization in Ohio.
- The requirement applies to traditional Medicare, including beneficiaries with Medigap Plan G or Plan N.
- Providers must obtain CMS approval before delivering covered services, or claims may be denied.
- CMS estimates up to 25% of U.S. health care spending is tied to low-value or unnecessary care.
- Reviews will use technology-supported clinical screening, including artificial intelligence tools.
- CMS has stated reviewers are not paid based on denials, limiting financial incentives to restrict care.
What Happens Next
- Prior authorization applies to services delivered on or after January 1, 2026.
- CMS will track spending, utilization, access, and outcomes through December 31, 2031.
- If CMS deems the model effective, the agency may expand it nationally or make it permanent.
- Provider advocates have raised concerns about care delays, particularly for rural and resource-limited organizations.
What to Do
- Confirm whether your services are included in the WISeR procedure list.
- Adjust ordering and scheduling workflows to account for authorization timelines.
- Track delays and denials to identify access or operational concerns.
- Communicate clearly with individuals and families about potential timing impacts.
- Document and share real-world effects with state and federal policymakers if care is delayed or disrupted.
CMS maintains details and the full list of affected procedures on its WISeR model information page. LeadingAge Ohio will continue to monitor implementation and share Ohio-specific guidance as it becomes available.
Related: House lawmakers debate, sharply disagree with new AI-driven prior-authorization used with WISer. Top U.S. Sens. Elizabeth Warren and Ron Wyden renewed their investigation into UnitedHealth Group’s nursing home operations in a January 7 follow-up letter to company leadership, citing reports that older adults died after care was denied or delayed. The senators raised concerns that cost-cutting incentives within UnitedHealth and its subsidiary, Optum, may be influencing clinical decisions in nursing home settings.
The inquiry reflects continued congressional scrutiny of whether financial incentives are putting nursing home residents at risk. LeadingAge has engaged directly with Senator Wyden’s office on the inquiry, underscoring members’ on-the-ground experience and the value of provider-run I-SNPs. The Centers for Medicare & Medicaid Services has launched a new online form allowing providers to directly submit complaints about Medicare Advantage plans through cms.gov. Provider submissions will feed directly into the Health Plan Management System Complaints Tracking Module, eliminating the need to upload original complaint forms.
According to a CMS memo outlining the process, complaints will be reviewed and triaged by CMS before being assigned to the appropriate contract. Providers can access and submit concerns using the Medicare Advantage provider complaint form now available on the CMS website. On Thursday, Feb. 5, from 2:00 to 3:30 p.m., a national webinar offered by the Administration for Community Living will spotlight how states are translating the National Strategy to Support Family Caregivers into action, with new federal grants accelerating outreach, coordination, and access to supports for family caregivers. The session will examine how federal and philanthropic investments are helping states build durable caregiver infrastructure. Administrators from the California Department of Aging, Maryland Department of Aging, Massachusetts Executive Office of Aging & Independence, and Wisconsin Department of Health Services will share early lessons and promising practices aligned with the Strategy’s five goals, including caregiver awareness efforts and better coordination across systems.
Register for the webinar on nashp.org. Top Residents have the right to choose their attending physician, and facilities may not interfere with that choice. Surveyors cite F555 when residents are not informed of this right, are not supported in selecting a physician, or are not kept informed of the name, specialty, and contact information for the physician and other primary care professionals responsible for their care. The attending physician is defined as the primary physician managing the resident’s medical care, not specialists seen periodically.
If a resident’s chosen physician is unable or unwilling to meet regulatory requirements, the facility must inform the resident and discuss alternative physician participation. Before seeking an alternate physician, the medical director must attempt to work with the attending physician or mediate differences. Only after those efforts fail may the facility assist the resident in selecting another physician, and the resident’s preferences must be honored. Surveyors will interview residents and staff to confirm that physician choice was respected and that residents were supported in identifying and contacting their attending physician. The Centers for Medicare & Medicaid Services acknowledged recent data problems on Nursing Home Care Compare in a January 9 Quality & Safety Special Alert Memo, confirming issues tied to the transition from the Quality Indicator Survey system to iQIES last summer. The shift, combined with delayed system updates following the federal government shutdown, led to discrepancies in health inspection data when Care Compare refreshed in November.
CMS said most inspection data issues were resolved in December, but unusually high complaint totals continued to appear in the health inspections domain. After concerns raised by LeadingAge and members, CMS announced it will remove complaint totals from Nursing Home Care Compare February 25, 2026 while it works on a more accurate way to display that information. LeadingAge welcomed the agency’s response and its commitment to improving the reliability of publicly reported data. Skilled nursing leaders continue to see regulation as a day-to-day operational strain rather than a policy problem on the horizon, according to McKnight’s 2026 Outlook survey. Nearly half of respondents ranked tighter compliance and regulatory standards among their top concerns for the year, trailing only staffing shortages and Medicaid cuts. Respondents pointed to frequent rule changes, inconsistent federal messaging, inexperienced surveyors, and growing documentation demands as factors that continue to weigh on clinical operations and administrative capacity, even after the repeal of the federal staffing mandate and a pause on certain ownership reporting requirements.
Concerns are especially pronounced around survey processes and quality measurement. Respondents cited the growing number of inexperienced surveyors, expanded antipsychotic quality measure calculations by the Centers for Medicare & Medicaid Services, and new Minimum Data Set reporting requirements as high-risk areas for 2026. Many leaders also flagged uncertainty tied to Medicaid policy changes and potential state-level funding cuts, noting that even flat Medicaid funding would further strain providers already operating on thin margins. While some respondents remain hopeful that additional regulatory relief may still emerge, the prevailing sentiment reflects caution and fatigue rather than confidence.
Read more in McKnight’s Long-Term Care News. Top United Church Homes has received $15,000 in grant funding to expand subsidized access to its NaviGuide service coordination program for low-income older adults in the Columbus area. The funding includes $10,000 from The Columbus Foundation’s Edythe G. Alberty Fund and $5,000 from The Harry C. Moores Foundation, allowing eligible older adults and families in Franklin and Delaware counties to access NaviGuide services at reduced cost.
NaviGuide provides personalized guidance to help older adults and their families navigate health care, housing, and community-based services. The new grants will support short-term subsidies for approximately 51 older adults who might otherwise be unable to afford the program. United Church Homes reports that prior NaviGuide subsidies helped individuals secure stable housing, connect to medical and dental care, and renew Medicaid coverage. More information about the program is available through NaviGuide service coordination on the United Church Homes website. 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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