Last week, LeadingAge Ohio provided an update on predictions on Mandamus payouts. Since then, the Ohio Department of Medicaid has made changes to its calculation methodology that will further delay payments from this week to possibly as early as next week.
LeadingAge Ohio and the other nursing facility associations recently reviewed preliminary provider-level estimates provided by the Ohio Department of Medicaid (ODM). However, an issue has now been identified involving managed care claims data from one of the health plans. This plan did not provide the claim-level detail necessary for ODM to incorporate those days into the claims-based calculation.
As a result, ODM has changed its calculation methodology. Rather than relying solely on claims-based days, the Department is looking to Medicaid cost report data—particularly the days reported on those cost reports—to calculate payments.
The change in methodology has resulted in changes to the preliminary estimates. For most providers, the difference from the earlier estimate is expected to be less than 10%. However, some providers are seeing significantly larger changes. In particular, providers with higher levels of PA1, PA2 or ventilator days may see substantial decreases from their earlier estimates, while other providers may see increases. Additional changes may be necessary as ODM determines how to account for dates not yet reflected in Medicaid cost report data.
It is important to note that the preliminary estimates shared previously were not final payment amounts. The calculations have continued to be reviewed and refined as ODM works to ensure that the appropriate data is incorporated.
ODM had anticipated issuing provider communications earlier this week and beginning the first round of payments on Friday. The change in methodology and resulting recalculations have delayed that timeline, with communications and payments possible as early as next week.
LeadingAge Ohio continues to stay in close contact with ODM and the other nursing facility associations as the Department works through the final calculations and payment process. We understand the frustration that another delay creates, particularly after the lengthy process leading to this point. We will continue to share information with members as soon as we have confirmed updates.
Providers should watch for communication from ODM through the Provider Network Module (PNM) system.