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08/09/2023

Four things nursing homes need to know about July 1, 2023 rate setting

Four things nursing homes need to know about July 1, 2023 ratesetting

LeadingAge Ohio has continued to work with the Department of Medicaid (ODM) to ensure timely, accurate ratesetting, reflecting the many payment changes included in the SFY2024-2025 budget.

Below are four key updates that providers should know, as they anticipate their July payments.  

  1. Some providers have noted their claims have remained in “pending” status despite the rate packages being released last Tuesday. LeadingAge Ohio met with ODM on Monday and learned that payments will be processed late Friday into Saturday, to be paid next Thursday (August 17th).
  2. A small number of providers (39) had incorrect scores on the pressure ulcer measure within the quality incentive payment resulting from a keying error by ratesetting. ODM has identified the issue, and will be issuing revised rate packages to those providers whose scores were impacted. Rates for these providers should load correctly and on time.
  3. The occupancy-based portions of the formula (occupancy measure under the quality incentive payment and the low occupancy penalty) were incorrectly calculated for some providers that recently underwent a change of operator. When calculating the QIP occupancy measure and low occupancy penalty, ODM should have used the exiting operator’s occupancy scores, but the rates did not reflect this.  ODM will resolve this issue ahead of loading the new rates into MITS for payment.
  4. Conversations continue regarding the level of the quality incentive payment. This morning, LeadingAge Ohio joined the other two nursing facility associations in submitting a joint rate reconsideration request to ODM on behalf of an estimated 822 Ohio nursing facilities that received the quality incentive payment. LeadingAge Ohio will provide a complete overview of the issue in tomorrow’s edition of The Source.

Questions regarding any of these items may be directed to Susan Wallace at swallace@leadingageohio.org.

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