April 19, 2024

Ohio House Sub Bill Summary:
Need to Know

Last week, the Ohio House of Representatives released its iteration of the biennial budget, outlining its priorities for the coming two years. The House was under additional pressure as the Office of Management and Budget estimated an additional $800 million shortfall that needed to be accommodated. The House successfully stripped $630 million from the executive budget levels, some of it at a cost to senior service providers.  Click the link below to send a THANK YOU to your Ohio Representative.

Thank Your Ohio Rep for Protecting Nursing Homes

The bill now moves onto the Senate for consideration, where a version is expected by mid-June. There follows a conference committee to reconcile any differences between the House and Senate versions, before it hits the Governor’s desk no later than June 30.

LeadingAge Ohio offers its members the following summary of the House Sub Bill budget provisions impacting long term care providers. The Senate is holding committee and standing subcommittee hearings on the operating appropriations bills.  LeadingAge Ohio is expecting to testify next week, outlining its principle concerns.

Sub HB 49 (Smith) Operating Budget Overview:

  • Continued decline in state revenue collection in current FY, requires an $800 million reduction in state General Revenue Funds (GRF) over the biennium to the budget as proposed;
  • House has stated it cut approximately $630 million GRF from the proposed budget;
  • Reduced the overall budget by $2.5 B over the biennium;
  • House reduced Medicaid State GRF spending by ($178 million) 3.8% in FY18 and ($307 million) or 6.31% in FY 19;
  • House spent an additional $170 million on opiate epidemic;
  • House spent an additional $80 million on primary education; 

The Senate is looking to set its own priorities and is anticipating it will cut more spending than the House in addition to the necessary balance to achieve the $800 million required reduction or steeper depending on how the state finishes the current SFY; 

Nursing Homes:

  • Eliminates the seven-percent cut to nursing facilities that was in the executive budget, but implements an annual spending cap for nursing facilities as a cost containment measure;
    • Provides that the total amount of payments for nursing facility services provided under Medicaid fee-for-service and MyCare Ohio cannot exceed $2,659,167,368 for fiscal year 2018 and $2,664,485,703 for fiscal year 2019. Requires that nursing facilities' rates be decreased as necessary to ensure that the total amount of the payments equals those amounts;
  • Creates changes to nursing facility rate formula;
    • Allows, instead of prohibiting, the use of the index maximizer element of the grouper methodology used in determining nursing facilities' case-mix scores.
    • Eliminates, for the purpose of qualifying as a critical access nursing facility, a requirement that a nursing facility have been awarded at least five points for meeting accountability measures.
    • Eliminates the rate add on from the portions of a nursing facility's total rate that are used in determining a critical access nursing facility's incentive payment.
    • Makes changes to the quality indicators used for the purpose of the quality portion of nursing facilities' rates.
      • Removes potential preventable admissions (PPA) and includes the target percentage of the NF’s long-stay residents that had an unplanned weight loss.
    • Provides for adjustments beginning in state fiscal year 2020 in an amount that equals the difference between the Medicare skilled nursing facility market basket index and a budget reduction adjustment factor.
    • States the General Assembly's intent to enact laws that specify the budget reduction adjustment factor for each state fiscal year.
    • Sets the budget reduction adjustment factor at zero for a state fiscal year if the General Assembly fails to enact such a law for that year.
  • Increases nursing facility funding $60 million (All funds) in FY ‘18 and $40 million (All funds) in FY ‘19;
  • Prohibits nursing facilities from being added to Medicaid managed care (MLTSS) before January 1, 2021. This does not apply to the MyCare Ohio program;
  • Requires a study committee to review nursing facilities and MLTSS and submit a report by June 30, 2020;
  • Creates a nursing facility bed conversion pilot in Cuyahoga County that allows a nursing facility the opportunity to voluntarily convert NF beds for use for substance use disorder treatment services. Requires DOM to complete a report on the pilot by October 1, 2019;
  • Extends a Medicaid demonstration project in Lucas County under which recipients receive nursing facility services instead of hospital services in a free-standing long-term care hospital. Adds facilities in Brown and Seneca counties. Allows facilities built after January 1, 2010 to be eligible;
  • Reduces the number of years ODM has to notify a nursing facility or Intermediate Care Facility (ICF) of an overpayment from five (5) to three (3) years; 

Home and Community-Based Services:

  • Prohibits home and community-based waiver services from being added to Medicaid managed care (MLTSS) before January 1, 2021. (This does not apply to the MyCare Ohio program).
  • Removes HCBS rate increases as proposed by the Governor for Assisted Living Waiver (ALW) and PASSPORT;
  • Creates a workgroup to review the ALW program and specifies membership, that includes LeadingAge Ohio, however, prohibits ALW from being offered in a setting other than a residential care facility (As requested by us and supported by the Administration). Encourages making community-based services that are similar to AL services available under other current Ohio Department of Aging (ODA) programs, or under a new program.  Requires the workgroup to complete a report by July 1, 2018;
  • Specifies that home health care is an in-demand industry sector

Housing:

  • Revises the fees for county recorder charges. Removes the $50 M cap of the fees deposited into the Low- and Moderate-Income Housing Trust Fund. Eliminates the Housing Trust Reserve Fund. Provides that of the amount into the Trust Fund, $6 M shall be provided to the Department of Mental Health and Addiction Services (MHA) to advance housing opportunities for individuals exiting residential opiate treatment.

Ohio Department of Health:

  • Removes the language in the Executive budget that increased ODH’s sanctioning scope in RCFs by providing ODH the authority to impose civil penalties;
  • Includes no provision that affords the director of ODH the authority to issue an “order” requiring a home to immediately address an issue if the director concludes that “immediate action is necessary to protect the health or safety of one or more residents of a home and the home has failed to act with sufficient promptness or efficiency to protect resident health or safety”;
  • Requires the ODH Director to administer an expedited review process for the certificate of need (CON) program in addition to the process currently in use;
  • Requires the ODH Director to issue a reviewable activity ruling not later than 14 days after receiving a request accompanied by information necessary to make the ruling, rather than the usual 45 day after receiving the request and information;
  • Reduces response and comment times in the expedited CON review process and requires the Director to grant or deny an application in expedited review not later than 30 days after mailing notice that the application is complete, rather than 60 day after the notice is mailed;
  • Provides that a nursing facility does not need to be inspected to receive new beds before the Department of Health increases its licensed beds if the beds are in an area that was part of the most recent inspection;
  • Provides that a change in the owner of a long-term care facility for which a Certificate of Need was granted occurs within the 5 year monitoring window and is not a reviewable activity unless there is a violation of law;
  • Repeals language regarding palliative care facility licensure that was removed from HB470, however was drafted in error when LSC was preparing committee report.

Other:

  • Requires the Department of Job and Family Services (JFS) to develop a registry for suspected elder abuse, create an obligation for some financial professionals to protect the elderly from financial crimes and establishes the Ohio Elder Abuse Commission;
  • Requires the Department of Job and Family Services (JFS) to develop a registry for suspected elder abuse, create an obligation for some financial professionals to protect the elderly from financial crimes and establishes the Ohio Elder Abuse Commission;
  • Prohibits the Department of Medicaid (MCD) from increasing provider rates or rolling new populations into managed care without the approval of the Joint Medicaid Oversight Committee (JMOC), subject to full GA veto. Returns Medicaid eligibility determination to the GA;
  • Changes to Medicaid expansion:
    • Transfer the state's share of Medicaid expansion funding to a different fund;
    • Release it upon request from the Ohio Department of Medicaid (ODM) every six months;
    • Release of the funding could be subject to certain conditions, such as seeking waivers from the federal government and enforcing a law on price transparency; 

To review the LeadingAge Ohio summary of the executive (“As Introduced”) version of the budget, click here. If you have a question about the budget or about grassroots advocacy, contact Nisha Hammel, Director of advocacy, at nhammel@leadingageohio.org.