As reported in The Source, the Ohio Department of Medicaid (ODM) has been working on updating the Nursing Facility: ventilator program rule 5160-3-18 to include ventilator weaning services. Cheryl Guyman, Nursing Facility Policy Administrator, reported that the final rule is anticipated to be effective January 1, 2019.
ODM has revised the payment methodology, basing it on a similar patient population (i.e. patients receiving vent services in a long-term acute care hospital (LTACH)). As a result, the ventilator only services rate will increase from $645 per day to $754.20 (fifty percent of the statewide average of the total per medicaid day payment rate for those individuals receiving ventilator services in a LTACH for the prior calendar year), and the ventilator weaning rate would be $905.06 per day ( sixty percent of the statewide average of the total per medicaid day payment rate for those individuals receiving ventilator services in a LTACH for the prior calendar year). The rule specifies that the weaning rate is limited to ninety (90) days per calendar year per individual, with a post ventilator weaning evaluation period of up to fourteen days. After the 90 days, the rate drops to the enhanced ventilator rate.
The rule includes additional requirements on ventilator weaning services as well as changes around requesting ODM approval, change of provider (CHOP) and the quality reporting program. ODM is working on a new form when requesting to participate in the ODM Nursing Facility Ventilator Program, but providers may use the current form until the new form is ready. Ms. Guyman indicated that interested providers wishing to become approved for ventilator weaning services may contact her at nfpolicy@medicaid.ohio.gov in advance of the rule becoming final.