03/26/2026

Medicaid Scrutinizes Ventilator Program

This week, LeadingAge Ohio met with the Department of Medicaid on its ongoing efforts to refine its nursing home ventilator program. In previous meetings, Medicaid had outlined concerns related to the dramatic increase in individuals being served under the ventilator program using non-invasive ventilators, as well as MDS data that demonstrated that some individuals who were being served by the ventilator program were otherwise coded as low-acuity. 

The focus of this week’s meeting was on recoupments being issued by Ohio’s managed care plans, and provider concerns that these recoupments were not justified by the current rule. Additionally, LeadingAge Ohio provided preliminary feedback to the Department on a draft proposed rule that would dramatically revise the program, increasing staffing requirements and creating an add-on payment for non-invasive ventilation, as well as instituting prior authorization for 100 percent of non-invasive ventilation services. 

LeadingAge Ohio has assembled a group of members who are reviewing the rule, which has not yet been shared publicly, and welcomes members to participate in this process. If your organization is part of Ohio’s ventilator program, please contact Susan Wallace at swallace@leadingageohio.org to be included in the review.