07/02/2026

ODM Announces Lower Ventilator Rates, Confirms New Complex NIV Payment Path

The Ohio Department of Medicaid (ODM) has released updated nursing facility ventilator program rates effective July 1, 2026, along with advance notice of significant program changes expected later this year. While the updated rates represent a substantial reduction from the prior year's reimbursement, the guidance also confirms that ODM intends to move forward with enhanced reimbursement for complex non-invasive ventilation (NIV) services under a redesigned ventilator program.

The revised fact sheet states that, beginning no earlier than Oct. 1, 2026, approved nursing facilities will be eligible to receive an enhanced payment for complex NIV services through a fee-for-service prior authorization process once new administrative rules take effect. LeadingAge Ohio views this as an important step, providing written confirmation that ODM intends to recognize and reimburse complex NIV services as the redesigned program is implemented.

ODM also indicates that the revised rules will include updated definitions, billing guidance, expanded provider eligibility and accountability requirements, and a new application process. All current and prospective ventilator program providers will be required to submit an updated application under the revised requirements. The proposed rules are expected to be released through the formal rulemaking process in the coming months.