LeadingAge Ohio joined the Ohio Department of Medicaid (ODM), the Ohio Health Care Association and the Academy of Senior Health Sciences today for a long-awaited update on the distribution of Quality Incentive Payment (QIP) dollars owed to nursing facilities following the Ohio Supreme Court's mandamus decision in September.
ODM emphasized that the department is actively preparing for distribution pending final guidance from the Centers for Medicare & Medicaid Services (CMS) on how the payments should be made.
The department said it remains confident that CMS will approve the federal match for the payments, which comprises 65% of the funding. The remaining question is whether the funds can be distributed directly by ODM as a single lump-sum payment to nursing facilities— the department's preferred approach — or whether they must flow through the managed care organizations, which would add additional complexity and likely extend the timeline. This is complicated by the fact that Ohio has reprocured managed care plans for NextGen Medicaid and NextGen MyCare programs in the intervening years, so does not have an active contract with some managed care organizations that would be part of distribution of funds.
ODM shared several additional updates:
- The department has completed preliminary payment calculations and will provide provider-level data to the associations for review before payments are issued.
- Associations will have an opportunity to review the calculations for accuracy, identifying any potential discrepancies and providing feedback before distributions are finalized. Associations may not share this data with members, however.
- A follow-up meeting will be scheduled after that review.
- The department is also developing a process for nursing facilities that experienced a change of ownership during the affected period, including an online portal to collect the information needed to distribute payments appropriately.
LeadingAge Ohio asked specifically about the treatment of hospice pass-through payments, noting that many hospice providers are already receiving inquiries from nursing facility partners. ODM acknowledged the issue and committed to providing additional guidance.
While no payment timeline was announced, ODM stressed that it is completing as much work as possible while awaiting CMS direction so payments can move forward as quickly as possible once approval is received.
LeadingAge Ohio will continue working closely with the department as this process moves forward and will share additional information as it becomes available. Questions may be directed to Eli Faes at efaes@leadingageohio.org.
