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08/07/2019

ODM Clarifies July 1 Rates, Market Basket Increase Takes Effect July 18

Earlier this week, the Ohio Department of Medicaid (ODM) announced Medicaid payment rates for nursing facilities beginning July 1, 2019. The attached memo outlines how to bill the nursing facility claims with multiple details in order to ensure proper payment. ODM has requested that providers not bill before Friday, August 9. Per ODM “This will allow all of the programming to be in place so that no more claims are set to suspend and they are properly adjudicated.”

In early July, ODM had delayed release of the rates, pending the final passage of the budget bill.

SB171, the 17-day interim budget passed by the Ohio General Assembly on June 30, held appropriations for Medicaid programs at SFY 2019 levels for July 1-17, allowing additional time for the Conference Committee on HB 166 to reconcile differences on the SFY 2020-2021 budget bill. ODM has confirmed that for July 1-17, nursing facility rates will match June 30 rates. Beginning on July 18, nursing facility rates will reflect the 2.4% market basket increase as well as case mix changes that were originally set to take effect July 1.

LeadingAge Ohio is actively working with ODM and other stakeholders to quickly address a number of outstanding concerns related to the vetoes pertaining to the nursing facility payment policy, including restoring the funding that nursing facilities would have received had the budget been completed timely, as well as another rate change set to take effect in October. Changes to budget language would need to be included in legislation approved by the House and Senate when they return to session in September.

Questions related to nursing facility rates may be directed to Susan Wallace, Director of Government Relations and Public Affairs at swallace@leadingageohio.org or (614) 545-9024.

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