Senate Budget Bill (HB49):
What You Need to Know

 On June 21, the Ohio Senate passed its version of the HB49, the State’s biennial budget.  The bill moves to conference committee where House and Senate members will work to reconcile the differences between the House-passed and Senate-passed versions. The members of the Conference Committee on HB49 are Representatives Ryan Smith (R-Gallipolis), Scott Ryan (R-Newark) and Jack Cera (D-Bellaire) and Senators Scott Oelslager (R-North Canton), Gayle Manning (R-North Ridgeville) and Mike Skindell (D-Lakewood). The first meeting of the group is set for Thursday, June 22.         

LeadingAge Ohio offers its members the following summary of the Senate Sub Bill budget provisions impacting long term care providers.

Nursing Homes:

• Retains the nursing facility funding of $100 million included in the House version; (as requested by LeadingAge Ohio)
• Maintains the House provision that excludes low resource utilization residents from a nursing facility's quarterly case-mix score determination;
• Retains changes to the nursing facility rate formula as included by the House with one change to the quality measures:
  • For the quality indicator related to receiving antipsychotics, it excludes residents who receive the meds in conjunction with hospice care.(as requested by LeadingAge Ohio)
• Replaces the Executive provision on the alternative purchasing model for nursing facilities with a provision that sets the rate at 34%, instead of 60%, of the statewide average of the per Medicaid day payment rate for long-term acute care hospital services;
• Retains the extension of 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, but provides for one of the additional facilities that is to participate to be located in Sandusky rather than Seneca County, retains Brown.

Home and Community-Based Services:

• Removes the prohibition on the Department of Medicaid to restructure rates for Assisted Living and personal care aides;
• Removes the Assisted Living Waiver workgroup;
• Maintains the Money Follows the Person (MFP) Demonstration but eliminates the opportunity for the Director of ODM in operating the Helping Ohioans Move, Expanding (HOME) Choice Program, to use state funds if no funds are available under a Money Follows the Person (MFP) demonstration project or integrate the component into a Medicaid waiver program;
• Retains the proposal from the Executive Budget that requires that the portions of civil money penalties that are imposed against home health agencies under a federal regulation and disbursed to ODM be deposited into the Residents Protection Fund, but specifies that these funds are to be used to improve the quality of Medicaid services provided by Medicare-certified home health agencies, instead of for the existing purposes of the Residents Protection Fund.

Medicaid Managed Care Long-Term Services and Supports (MLTSS):

• Changes the House “Medicaid Managed Care Long-Term Services and Supports Study Committee" name to the "Patient-Centered Medicaid Managed Care Long-Term Services and Supports Study Committee."; modifies the committee's membership and duties; and changes the date the committee must produce a report to not later than December 31, 2018.
• Requires the General Assembly to consider and vote not later than December 31, 2018, on legislation that would authorize the inclusion of nursing facility services and home and community-based waiver services in the Medicaid managed care system. This does not apply to the MyCare Ohio program;
• Provides for an ongoing committee called the Patient-Centered Medicaid Long-Term Care Delivery System Advisory Committee to be established if the General Assembly enacts legislation authorizing the inclusion of nursing facility services and home and community-based waiver services in the Medicaid managed care system. Provides for the on-going committee to have the same type of membership as the temporary committee. Requires the employees of the Joint Medicaid Oversight Committee to provide the ongoing committee administrative assistance and ODM to provide it updates about the inclusion of nursing facility services and home and community-based waiver services in the Medicaid managed care system. Requires the ongoing committee to complete quarterly reports.
• Requires ODM, if it expands the inclusion of the aged, blind, and disabled Medicaid eligibility group or dual eligible individuals in the Medicaid managed care system during the 2018-2019 fiscal biennium, to:
  • Require area agencies on aging to be the coordinators of the home and community-based waiver services that the eligibility group and those individuals receive;
  • Permit Medicaid MCOs to delegate to area agencies on aging full-care coordination functions for those services and other health-care services, and;
  • Give preference, when selecting Medicaid MCOs, to organizations that will enter into subcapitation arrangements with area agencies on aging under which the agencies perform, in addition to other functions, network management and payment functions for those services.
    

Ohio Department of Health:

• Retains the House language that a nursing facility does not need to be inspected before the ODH Director increases its licensed capacity but specifies that the exemption applies if the resident rooms to which the beds will be added were inspected (as part of the nursing home's most recent inspection) for the same number of residents proposed to be placed in a room after the capacity increase;
• Eliminates the requirement that the ODH Director administer an expedited review process for the certificate of need (CON) program in addition to the process currently in use; Retains the House language that provides that a change in the owner of a long term care facility for which a CON was granted that occurs during the five-year period of monitoring by ODH is not a reviewable activity unless the new owner or operator is associated with certain violations specified in existing law; thus, allows the holder of a CON to transfer or sell a facility during the five-year period without requiring the new owner or operator to submit a CON application and pay the application fee.

Other:

• Removes the language that prohibits the Department of Medicaid (MCD) from increasing provider rates without the approval of the Joint Medicaid Oversight Committee (JMOC), subject to full General Assembly (GA) veto;
• Retains the House language that abolishes the patient-centered medical home program (Comprehensive Primary Care, CPC);
• Freezes Group VIII enrollment (Medicaid expansion enrollment), starting July 1, 2018. Under this language, once an individual is ineligible for enrollment under expansion for any reason the individual is no longer able to re-enroll under expansion;
• Includes requirements that only those working, in school, over 55 years old, in a treatment program, or with a severe mental or physical illness will be able to keep coverage starting in 2017. This language, commonly referred to as a “work requirement” means that someone looking for a job, or waiting for a spot to open up in a treatment program, will lose their health care entirely;
• Requires the Medicaid Director to resubmit a request for a federal Medicaid waiver needed to implement the Healthy Ohio Program not later than January 31, 2018.

LeadingAge Ohio has previously provided summaries of the Executive (“As Introduced”) and House versions of the budget. If you have a question about the budget or about grassroots advocacy, contact Nisha Hammel, Director of Advocacy, at nhammel@leadingageohio.org.