12/14/2023

ODM Shares Details on Private Room Applications

This morning, the Ohio Department of Medicaid (ODM) sent a notice to all nursing facility operators that included detailed instructions which will allow providers to prepare to submit applications to receive private room payments in CY2024. 

The entirety of the notice was as follows:

House Bill 33 authorized $160 million over the biennium for Medicaid private room payments. Payments will be made based on two categories of rooms:

*  Category One: $30 per day for private rooms with a private bath (toilet and sink).

*  Category Two: $20 per day for private rooms with a bath shared with one other person.

Beginning January 2, 2024, at 8:00 AM, pursuant to Am. Sub. H.B. 33 and Ohio Revised Code 5165.158, nursing facilities may apply to ODM to receive private room incentive payments for providing private rooms to Medicaid recipients. ODM is developing an online application and has filed emergency Ohio Administrative Code rule 5160-3-16.31 to facilitate this process. The application will be available by clicking this link.

The application for Category One private rooms will be available beginning January 2, 2024, at 8:00 AM, and will remain open until all funds are allocated. The application process will require nursing facilities to provide ODM with the information about the rooms for which the nursing facility is seeking an incentive payment, and to upload supporting documentation.

The application will require:

1. The Medicaid ID of the facility. 
2. Name and email address of the person submitting the application.
3. Total number of nursing facility beds licensed by the Ohio Department of Health as of January 1,  2024. If county-owned, the number of certified beds as of January 1, 2024.
4. Number of Category One beds for which an incentive payment is being requested.

The application will require that nursing facilities identify how the private rooms were created by selecting all scenarios that apply in the application. These include

1. Private rooms were in existence on July 1, 2023, and all of the licensed beds were in service on the application date.
2. Private rooms were created by surrendering licensed beds from its licensed capacity, or, if the nursing facility does not hold a license, surrendering beds that have been certified by CMS. A nursing facility where the beds are owned by a county and the facility is operated by a person other than the          county may satisfy this requirement by removing beds from service.
3. Private rooms that will be created by surrendering licensed beds from its licensed capacity, or, if the nursing facility does not hold a license, surrendering beds that have been certified by CMS.       A nursing facility where the beds are owned by a county and the facility is operated by a person other than the      
   NOTE: Surrendering beds does not need to be complete at the time of application but will need to be complete before an application can be approved by ODM.
4. Private rooms were created by adding space to the nursing facility or renovating non-bedroom space, without increasing the total licensed bed capacity.
   NOTE: Renovating space needs to be complete before an application can be approved, but renovations do not need to be complete at the time of application.
5. A nursing facility licensed after July 1, 2023, in which all licensed beds are in service on the application date or in which private rooms were created by surrendering licensed beds from its licensed capacity.

The application will also require that nursing facilities upload the following supporting documentation:

1. A .pdf document (maximum of 10 MB) list of all nursing facility rooms and their corresponding number of beds, designating the rooms for which private room incentive payment approval is requested and identifying which rooms are Category One as defined in section 5165.158 of the Revised Code.
2. Up to five .pdf documents (maximum of 10 MB each) that show the floor plan of the entire nursing facility that identifies each private room with the designated room number and designated bathroom. Arrows should indicate the path between each resident room and the bathroom and each resident room and the hallway.

All required documents must be in .pdf format.  All document file names must begin with the provider's seven-digit Medicaid ID as the first seven characters of the file name. All files submitted must be clear and legible.

Upon submission of the application, submitters will receive an email from NF_PrivateRoom@medicaid.ohio/gov  that confirms receipt of the application and includes their responses to all questions. If you are submitting an application for more than one  nursing facility, you must close and relaunch a new application for each Medicaid Provider ID.

Applications will be held in a pending status in the order submitted until the Centers for Medicare and Medicaid Services (CMS) approves private room incentive payments and the department determines a nursing facility is qualified to receive the private room incentive payment. The department will notify nursing facilities of the opportunity to submit an application beginning March 1, 2024, to receive incentive payments for Category Two beds, based on available funding.

Additional information may be requested by ODM to ensure a nursing facility's eligibility. Facilities will have 10 business days from the date of the request to provide this additional information. Failure to submit the requested information within 10 business days will invalidate the original application's submission and place in line. The nursing facility may submit a new application, which will be considered chronologically based on the new submission date. 

Submit any questions to NF_PrivateRoom@medicaid.ohio.gov . ODM sincerely thanks you for your participation in this process.

Unfortunately, the link taking providers to the application portal was omitted from this morning’s notice. In a meeting with LeadingAge Ohio this morning, ODM indicated it would be re-sending the notice today with the corrected link. Additionally, the notice omitted a required attestation that would be completed by the individual completing the application. There is no requirement for whom this individual should be– only that it be completed by an organization’s designee at the time of application. 

ODM is also working on the permanent rule to replace the emergency rule filed earlier this month, that will outline the administration of the private room payments moving forward. LeadingAge Ohio is reviewing the rule, which is not yet available to the public. 

LeadingAge Ohio strongly encourages nursing facility members to join the All Member Webinar which will provide a detailed overview of the application process next Tuesday, December 19 at 11:30am. Questions may be directed to Susan Wallace at swallace@leadingageohio.org.