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As Introduced
136th
General Assembly
Regular
Session
S. B. No. 390
2025-2026
Senators Cutrona, Patton
Cosponsor: Senator Lang
To
amend sections 5165.06, 5165.151, 5165.158, 5165.19, 5165.26, and
5165.36 and to enact section 5165.061 of the Revised Code
to
make various changes to the law governing nursing facilities in the
Medicaid program.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 5165.06, 5165.151, 5165.158, 5165.19, 5165.26, and 5165.36
be amended and section 5165.061 of the Revised Code be enacted to
read as follows:
Sec.
5165.06.
Subject
to
section
sections
5165.061 and
5165.072
of the Revised Code, an operator is eligible to enter into and retain
a provider agreement for a nursing facility if all of the following
apply:
(A)
The nursing facility is certified by the director of health for
participation in medicaid;
(B)
The nursing facility is licensed by the director of health as a
nursing home if so required by law and the operator is the licensed
operator of the nursing home;
(C)
The operator and nursing facility comply with all applicable state
and federal laws and rules.
Sec.
5165.061.
(A)
An operator is not eligible to enter into a provider agreement for a
nursing facility under section 5165.06 of the Revised Code for a
period of five years after the last effective date of a change of
operator for the nursing facility if the effective date of the change
of operator occurs after the effective date of this section.
(B)
Notwithstanding division (A) of this section, the department of
medicaid may permit an operator to enter into a provider agreement
for a nursing facility if the department determines, in accordance
with rules authorized under section 5165.02 of the Revised Code, that
there is an emergency that is not a fiscal emergency that
necessitates an operator entering into a provider agreement.
Sec.
5165.151.
(A)
The total per medicaid day payment rate determined under section
5165.15 of the Revised Code shall not be the initial rate for nursing
facility services provided by a new nursing facility. Instead, the
initial total per medicaid day payment rate for nursing facility
services provided by a new nursing facility shall be determined in
the following manner:
(1)
The initial rate for ancillary and support costs shall be the rate
for the new nursing facility's peer group determined under division
(C) of section 5165.16 of the Revised Code.
(2)
The initial rate for capital costs shall be the rate for the new
nursing facility's peer group determined under division (C) of
section 5165.17 of the Revised Code;
(3)
The initial rate for direct care costs shall be the product of the
cost per case-mix unit determined under division (C) of section
5165.19 of the Revised Code for the new nursing facility's peer group
and the new nursing facility's case-mix score determined under
division (B) of this section.
(4)
The initial rate for tax costs shall be the following:
(a)
If the provider of the new nursing facility submits to the department
of medicaid the nursing facility's projected tax costs for the
calendar year in which the provider obtains an initial provider
agreement for the new nursing facility, an amount determined by
dividing those projected tax costs by the number of inpatient days
the nursing facility would have for that calendar year if its
occupancy rate were one hundred per cent;
(b)
If division (A)(4)(a) of this section does not apply, the median rate
for tax costs for the new nursing facility's peer group in which the
nursing facility is placed under division (B) of section 5165.16 of
the Revised Code.
(5)
The initial quality incentive payment rate for the new nursing
facility shall be the amount determined under section 5165.26 of the
Revised Code.
(6)
Sixteen dollars and forty-four cents shall be added to the sum of the
rates and payment specified in divisions (A)(1) to (5) of this
section.
(B)
For the purpose of division (A)(3) of this section, a new nursing
facility's case-mix score shall be the following:
(1)
Unless the new nursing facility replaces an existing nursing facility
that participated in the medicaid program immediately before the new
nursing facility begins participating in the medicaid program, the
median annual average case-mix score
that
includes each resident who is a medicaid recipient and is not a low
case-mix resident
for
the new nursing facility's peer group.
(2)
If the nursing facility replaces an existing nursing facility that
participated in the medicaid program immediately before the new
nursing facility begins participating in the medicaid program, the
semiannual case-mix score most recently determined under section
5165.192 of the Revised Code for the replaced nursing facility as
adjusted, if necessary, to reflect any difference in the number of
beds in the replaced and new nursing facilities.
(C)
Subject to division (D) of this section, the department of medicaid
shall adjust the rates established under division (A) of this section
effective the first day of July, to reflect new rate calculations for
all nursing facilities under this chapter.
(D)
If a rate for direct care costs is determined under this section for
a new nursing facility
using
the median annual average case-mix score for the new nursing
facility's peer group
under
division (B)(1) of this section
,
the rate shall be redetermined to reflect the new nursing facility's
actual
semiannual
average
quarterly
case-mix
score determined under section 5165.192 of the Revised Code after the
new nursing facility submits its first
two
quarterly
assessment data that
qualify
qualifies
for
use in calculating a case-mix score in accordance with rules
authorized by section 5165.192 of the Revised Code. If the new
nursing facility's quarterly
submissions
do
submission
does
not
qualify for use in calculating a case-mix score, the department shall
continue to use the median annual average case-mix score for the new
nursing facility's peer group
under
division (B)(1) of this section
in
lieu of the new nursing facility's
semiannual
quarterly
case-mix
score until the new nursing facility submits
two
consecutive
quarterly
assessment data that
qualify
qualifies
for
use in calculating a case-mix score.
Sec.
5165.158.
(A)
As used in this section:
(1)
"Category one private room" means a private room that has
unshared access to a toilet and sink.
(2)
"Category two private room" means a private room that has
shared access to a toilet and sink.
(B)
Beginning
six months following approval by the United States centers for
medicare and medicaid services or on the effective date of applicable
department of medicaid rules, whichever is later, but not sooner than
April 1, 2024, the
The
total
per medicaid day payment rate for nursing facility services provided
on
or after that date
in
private rooms approved by the department of medicaid under division
(C) of this section shall be the sum of both of the following:
(1)
The total per medicaid day payment rate determined for the nursing
facility under section 5165.15 of the Revised Code;
(2)
The private room incentive payment. The private room incentive
payment shall be thirty dollars per day for a category one private
room and twenty dollars per day for a category two private room,
beginning in state fiscal year 2024. The department may increase the
payment amount for subsequent fiscal years.
(C)(1)
The department shall approve rooms in nursing facilities to qualify
for the rate described in division (B) of this section. A nursing
facility provider shall apply for approval of its private rooms by
submitting an application in the form and manner prescribed by the
department.
The
department shall begin accepting applications for approval of
category one private rooms on January 1, 2024, and category two
private rooms on March 1, 2024.
The
department may specify evidence that an applicant must supply to
demonstrate that a room meets the definition of a private room under
section 5165.01 of the Revised Code and may conduct an on-site
inspection of the room to verify that it meets the definition.
Subject to
division
divisions
(C)(2)
and (3)
of this section, the department shall approve an application if the
rooms included in the application meet the definition of a private
room under section 5165.01 of the Revised Code.
(2)
The department shall only consider applications that meet the
following criteria:
(a)
Private rooms that are in existence on July 1, 2023, in facilities
where all of the licensed beds are in service on the application
date;
(b)
Private rooms created by surrendering licensed beds from its licensed
capacity, or, if the 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.
(c)
Private rooms created by adding space to the nursing facility or
renovating nonbedroom space, without increasing the total licensed
bed capacity;
(d)
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.
(3)
Notwithstanding
division (C)(2) of this section, the department shall approve an
application for private rooms submitted by a newly constructed
nursing facility that was initially licensed on or after July 1,
2023, in which all licensed beds in the facility are located in
category one private rooms.
(4)
The
department may specify evidence that an applicant must supply to
demonstrate that it meets the conditions specified in division (C)(2)
or
(3)
of
this section and may conduct an on-site inspection to verify that the
conditions are met.
(4)
(5)
The department
may
shall
deny
an application if the department determines that any of the following
circumstances apply:
(a)
The rooms included in the application do not meet the definition of a
private room under section 5165.01 of the Revised Code;
(b)
The rooms included in the application do not meet the criteria
specified in division (C)(2) of this section;
(c)
The applicant created private rooms by reducing the number of
available beds without surrendering the beds, and surrender of the
beds is required by this section;
(d)
Approval
Except
for applications that are approved under division (C)(3) of this
section, approval
of
the room would cause projected expenditures for private room
incentive payments under this section for the fiscal year to exceed
forty
million dollars in fiscal year 2024 or
one
hundred sixty million dollars
in fiscal year 2025 or subsequent fiscal years
.
In projecting expenditures for private room incentive payments, the
department shall use a medicaid utilization percentage of fifty per
cent. If the department determines that there are more approvable
eligible applications submitted than can be accommodated within the
applicable spending limit specified in this division, the department
shall prioritize category one private rooms.
(e)
On the application date, the nursing facility is listed on table A or
table D of the SFF list, as defined in section 5165.01 of the Revised
Code or is designated as having a one-star overall rating in the
United States centers for medicare and medicaid services nursing
facility five-star quality rating system known as care compare.
(5)
Beginning July 1, 2025, to
(6)
To
retain
eligibility for private room rates, a nursing facility must do
both
all
of
the following:
(a)
Have a policy in place to prioritize placement in a private room
based on the medical and psychosocial needs of the resident;
(b)
Participate in the resident or family satisfaction survey performed
pursuant to section 173.47 of the Revised Code
;
(c)
Except for a new nursing facility that has not yet received its first
star rating, maintain a two-star or greater overall rating in the
United States centers for medicare and medicaid services nursing
facility five-star quality rating system known as compare care;
(d)
Not be listed on table A or table D of the SFF list, as defined in
section 5165.26 of the Revised Code
.
(6)
The department shall hold all applications for a private room
incentive payment in a pending status until the United States centers
for medicare and medicaid services approves private room incentive
payments and the department determines a facility is qualified for
the payment. An application in pending status shall be included in
the payment cap described in division (C)(4)(d) of this section as if
the application were approved.
(7)
If a nursing facility approved for private rooms under this section
becomes ineligible to receive private room incentive payments under
division (C)(6) of this section, the nursing facility's approval for
private rooms under this section shall be deemed withdrawn as of the
date the ineligibility occurs. A nursing facility that becomes
ineligible to receive private room incentive payments shall not seek
payment from the department for such payments on or after the date on
which the nursing facility becomes ineligible. A nursing facility
that becomes ineligible to receive private room incentive payments
shall notify the department in writing not later than thirty days
after the date on which ineligibility occurs.
(a)
A nursing facility that has its approval for private rooms withdrawn
under division (C)(7) of this section may reapply for approval under
this section when the nursing facility again meets the eligibility
requirements described in this section.
(b)
The department or its designee shall recoup any private room
incentive payments made for services provided on or after the date on
which a nursing facility becomes ineligible to receive private room
incentive payments. The department may impose a penalty not to exceed
five per cent of the amount recouped.
(8)
An applicant may request reconsideration of a denial under division
(C) of this section.
Sec.
5165.19.
(A)(1)
Semiannually, except as provided in division (A)(2) of this section,
the department of medicaid shall determine each nursing facility's
per medicaid day payment rate for direct care costs by multiplying
the facility's semiannual case-mix score determined under section
5165.192 of the Revised Code by the cost per case-mix unit determined
under division (C) of this section for the facility's peer group.
(2)
Beginning January 1, 2024, during state fiscal years 2024 and 2025,
the department shall determine each nursing facility's per medicaid
day payment rate for direct care costs by multiplying the cost per
case-mix unit determined under division (C) of this section for the
facility's peer group by the case-mix score specified in division
(A)(2)(a) or (b) of this section, as selected by the nursing facility
not later than October 1, 2023. If the nursing facility does not make
a selection by October 1, 2023, the case-mix score specified in
division (A)(2)(a) of this section shall apply. The case-mix score
may be either of the following:
(a)
The semiannual case-mix score determined for the facility under
division (A)(1) of this section;
(b)
The facility's quarterly case-mix score from March 31, 2023, which
shall apply to the facility's direct care rate from January 1, 2024,
to June 30, 2025.
(B)
For the purpose of determining nursing facilities' rates for direct
care costs, the department shall establish three peer groups.
(1)
Each nursing facility located in any of the following counties shall
be placed in peer group one: Brown, Butler, Clermont, Clinton,
Hamilton, and Warren.
(2)
Each nursing facility located in any of the following counties shall
be placed in peer group two: Allen, Ashtabula, Champaign, Clark,
Cuyahoga, Darke, Delaware, Fairfield, Fayette, Franklin, Fulton,
Geauga, Greene, Hancock, Knox, Lake, Licking, Lorain, Lucas, Madison,
Mahoning, Marion, Medina, Miami, Montgomery, Morrow, Ottawa,
Pickaway, Portage, Preble, Ross, Sandusky, Seneca, Stark, Summit,
Trumbull, Union, and Wood.
(3)
Each nursing facility located in any of the following counties shall
be placed in peer group three: Adams, Ashland, Athens, Auglaize,
Belmont, Carroll, Columbiana, Coshocton, Crawford, Defiance, Erie,
Gallia, Guernsey, Hardin, Harrison, Henry, Highland, Hocking, Holmes,
Huron, Jackson, Jefferson, Lawrence, Logan, Meigs, Mercer, Monroe,
Morgan, Muskingum, Noble, Paulding, Perry, Pike, Putnam, Richland,
Scioto, Shelby, Tuscarawas, Van Wert, Vinton, Washington, Wayne,
Williams, and Wyandot.
(C)(1)
Except as provided in division (C)(4) of this section, the department
shall determine a cost per case-mix unit for each peer group
established under division (B) of this section. The cost per case-mix
unit determined under this division for a peer group shall be used
for subsequent years until the department conducts a rebasing. To
determine a peer group's cost per case-mix unit, the department shall
do
both
all
of
the following:
(a)
Determine the cost per case-mix unit for each nursing facility in the
peer group for the applicable calendar year by dividing each
facility's desk-reviewed, actual, allowable, per diem direct care
costs for the applicable calendar year by the facility's annual
average case-mix score determined under section 5165.192 of the
Revised Code for the applicable calendar year;
(b)
Subject to division (C)(2) of this section, identify which nursing
facility in the peer group is at the seventieth percentile of the
cost per case-mix units determined under division (C)(1)(a) of this
section
;
(c)
For state fiscal year 2027, reduce the total cost per case-mix unit
in effect on June 30, 2026, by a percentage that reduces the total
expenditures on nursing facility per medicaid day payment rates by
seventy-one million dollars for that fiscal year;
(d)
For state fiscal year 2028, reduce the total cost per case-mix unit
in effect on June 30, 2027, by a percentage that reduces expenditures
on nursing facility per medicaid day payment rates by seventy-one
million dollars for that fiscal year;
(e)
For subsequent rebasings after state fiscal year 2028, reduce the
cost per case-mix units by the percentage determined under division
(C) of section 5165.36 of the Revised Code
.
(2)
In making the identification under division (C)(1)(b) of this
section, the department shall exclude both of the following:
(a)
Nursing facilities that participated in the medicaid program under
the same provider for less than twelve months in the applicable
calendar year;
(b)
Nursing facilities whose cost per case-mix unit is more than one
standard deviation from the mean cost per case-mix unit for all
nursing facilities in the nursing facility's peer group for the
applicable calendar year.
(3)
The department shall not redetermine a peer group's cost per case-mix
unit under this division based on additional information that it
receives after the peer group's per case-mix unit is determined. The
department shall redetermine a peer group's cost per case-mix unit
only if it made an error in determining the peer group's cost per
case-mix unit based on information available to the department at the
time of the original determination.
(4)
The department shall multiply each cost per case-mix unit determined
under division (C)(1) of this section by the peer group average
case-mix score in effect on December 31, 2025, divided by the peer
group average case-mix score determined under section 5165.192 of the
Revised Code for the semiannual period beginning January 1, 2026. The
product determined under this division for each nursing facility's
peer group shall be the cost per case-mix unit used to determine the
nursing facility's per medicaid day payment rate for direct care
costs under division (A)(1) of this section for the period beginning
January 1, 2026, and ending on the day before the department's next
rebasing conducted after that date takes effect.
Sec.
5165.26.
(A)
As used in this section:
(1)
"Base rate" means the portion of a nursing facility's total
per medicaid day payment rate determined under divisions (A) and (B)
of section 5165.15 of the Revised Code.
(2)
"CMS" means the United States centers for medicare and
medicaid services.
(3)
"Long-stay resident" means an individual who has resided in
a nursing facility for at least one hundred one days.
(4)
"Nursing facilities for which a quality score was determined"
includes nursing facilities that are determined to have a quality
score of zero.
(5)
"SFF list" means the list of nursing facilities that the
United States department of health and human services creates under
the special focus facility program.
(6)
"Special focus facility program" means the program
conducted by the United States secretary of health and human services
pursuant to section 1919(f)(10) of the "Social Security Act,"
42 U.S.C. 1396r(f)(10).
(B)
Subject to divisions (D) and (E) and except as provided in division
(F) of this section, the department of medicaid shall determine each
nursing facility's per medicaid day quality incentive payment rate as
follows:
(1)
Determine the sum of the quality scores determined under division (C)
of this section for all nursing facilities.
(2)
Determine the average quality score by dividing the sum determined
under division (B)(1) of this section by the number of nursing
facilities for which a quality score was determined.
(3)
Determine the sum of the total number of medicaid days for all of the
calendar year preceding the fiscal year for which the rate is
determined for all nursing facilities for which a quality score was
determined.
(4)
Multiply the average quality score determined under division (B)(2)
of this section by the sum determined under division (B)(3) of this
section.
(5)
Determine the value per quality point by determining the quotient of
the following:
(a)
The sum determined under division (E)(2) of this section.
(b)
The product determined under division (B)(4) of this section.
(6)
Multiply the value per quality point determined under division (B)(5)
of this section by the nursing facility's quality score determined
under division (C) of this section.
(C)(1)
Except as provided in divisions (C)(2) and (3) of this section, a
nursing facility's quality score for a state fiscal year shall be the
sum of the following:
(a)
The total number of points that CMS assigned to the nursing facility
under CMS's nursing facility five-star quality rating system for the
following quality metrics, or CMS's successor metrics as described
below, based on the most recent four-quarter average data, or the
average data for fewer quarters in the case of successor metrics,
available in the database maintained by CMS and known as nursing home
compare in the most recent month of the calendar year during which
the fiscal year for which the rate is determined begins:
(i)
The percentage of the nursing facility's long-stay residents at high
risk for pressure ulcers who had pressure ulcers;
(ii)
The percentage of the nursing facility's long-stay residents who had
a urinary tract infection;
(iii)
The percentage of the nursing facility's long-stay residents whose
ability to move independently worsened;
(iv)
The percentage of the nursing facility's long-stay residents who had
a catheter inserted and left in their bladder.
If
CMS ceases to publish any of the metrics specified in division
(C)(1)(a) of this section, the department shall use the nursing
facility quality metrics on the same topics that CMS subsequently
publishes.
(b)
Seven and five-tenths points for fiscal year 2024 and three points
for fiscal year 2025 and subsequent fiscal years if the nursing
facility's occupancy rate is greater than seventy-five per cent. For
purposes of this division, the department shall utilize the
facility's occupancy rate for licensed beds reported on its cost
report for the calendar year preceding the fiscal year for which the
rate is determined or, if the facility is not required to be
licensed, the facility's occupancy rate for certified beds. If the
facility surrenders licensed or certified beds before the first day
of July of the calendar year in which the fiscal year begins, the
department shall calculate a nursing facility's occupancy rate by
dividing the inpatient days reported on the facility's cost report
for the calendar year preceding the fiscal year for which the rate is
determined by the product of the number of days in the calendar year
and the facility's number of licensed, or if applicable, certified
beds on the first day of July of the calendar year in which the
fiscal year begins.
(c)
Beginning with state fiscal year 2025, the total number of points
that CMS assigned to the nursing facility under CMS's nursing
facility five-star quality rating system for the following quality
metrics, or successor metrics designated by CMS, based on the most
recent four-quarter average data available in the database maintained
by CMS and known as nursing home compare in the most recent month of
the calendar year during which the fiscal year for which the rate is
determined begins:
(i)
The percentage of the nursing facility's long-stay residents whose
need for help with daily activities has increased;
(ii)
The percentage of the nursing facility's long-stay residents
experiencing one or more falls with major injury;
(iii)
The percentage of the nursing facility's long-stay residents who were
administered an antipsychotic medication;
(iv)
Adjusted total nurse staffing hours per resident per day using
quintiles instead of deciles by using the points assigned to the
higher of the two deciles that constitute the quintile.
If
CMS ceases to publish any of the metrics specified in division
(C)(1)(c) of this section, the department shall use the nursing
facility quality metrics on the same topics CMS subsequently
publishes.
(2)
In determining a nursing facility's quality score for a state fiscal
year, the department shall make the following adjustment to the
number of points that CMS assigned to the nursing facility for each
of the quality metrics specified in divisions (C)(1)(a) and (c) of
this section:
(a)
Unless division (C)(2)(b) or (c) of this section applies, divide the
number of the nursing facility's points for the quality metric by
twenty.
(b)
If CMS assigned the nursing facility to the lowest percentile for the
quality metric, reduce the number of the nursing facility's points
for the quality metric to zero.
(c)
If the nursing facility's total number of points calculated for or
during a state fiscal year for all of the quality metrics specified
in divisions (C)(1)(a), and if applicable, division (C)(1)(c) of this
section is less than
a
number of points that is equal to the twenty-fifth percentile of all
nursing facilities, calculated using the points for the July 1 rate
setting of that fiscal year
thirty-two,
reduce
the nursing facility's points to zero until the next point
calculation. If a facility's recalculated points under division
(C)(3) of this section are below
the
number of points determined to be the twenty-fifth percentile for
that fiscal year
thirty-two
,
the facility shall receive zero points for the remainder of that
fiscal year.
(3)
A nursing facility's quality score shall be recalculated for the
second half of the state fiscal year based on the most recent four
quarter average data, or the average data for fewer quarters in the
case of successor metrics, available in the database maintained by
CMS and known as the care compare, in the most recent month of the
calendar year during which the fiscal year for which the rate is
determined begins. The metrics specified by division (C)(1)(b) of
this section shall not be recalculated. In redetermining the quality
payment for each facility based on the recalculated points, the
department shall use the same per point value determined for the
quality payment at the start of the fiscal year.
(D)
A nursing facility shall not receive a quality incentive payment if
the Department of Health assigned the nursing facility to the SFF
list under the special focus facility program and the nursing
facility is listed in table A, on the first day of May of the
calendar year for which the rate is being determined.
(E)
The total amount to be spent on quality incentive payments under
division (B) of this section for a fiscal year shall be determined as
follows:
(1)
Determine the following amount for each nursing facility:
(a)
The amount that is five and two-tenths per cent of the nursing
facility's base rate for nursing facility services provided on the
first day of the state fiscal year plus one dollar and seventy-nine
cents
plus sixty per cent of the per diem amount by which the nursing
facility's cost per case-mix unit changed as a result of the rebasing
conducted under section 5165.36 of the Revised Code. The nursing
facility's cost per case-mix unit is determined under division (C) of
section 5165.19 of the Revised Code and for purposes of this division
shall not be multiplied by the facility's semiannual case-mix score
determined under section 5165.192 of the Revised Code
.
(b)
Multiply the amount determined under division (E)(1)(a) of this
section by the number of the nursing facility's medicaid days for the
calendar year preceding the fiscal year for which the rate is
determined.
(2)
Determine the sum of the products determined under division (E)(1)(b)
of this section for all nursing facilities for which the product was
determined for the state fiscal year.
(3)
To the sum determined under division (E)(2) of this section, add
one
three
hundred
twenty-five
sixty-six
million
dollars
.
(4)
Unless there is a rebasing conducted under section 5165.36 of the
Revised Code for state fiscal year 2028, beginning in state fiscal
year 2028, add seventy-one million dollars to the sum determined
under division (E)(3) of this section.
(5)
To the sum determined under division (E)(4) of this section, for the
next rebasing conducted under section 5165.36 of the Revised Code and
any subsequent rebasing, add the sum of the amounts determined under
division (B) of section 5165.36 of the Revised Code for each
rebasing
.
(F)(1)
Beginning July 1, 2023, a new nursing facility shall receive a
quality incentive payment for the fiscal year in which the new
facility obtains an initial provider agreement and the immediately
following fiscal year equal to the median quality incentive payment
determined for nursing facilities for the fiscal year. For the state
fiscal year after the immediately following fiscal year and
subsequent fiscal years, the quality incentive payment shall be
determined under division (C) of this section.
(2)
A nursing facility that undergoes a change of operator with an
effective date of July 1, 2025, or later shall not receive a quality
incentive payment until the earlier of the first day of January or
the first day of July that is at least six months after the effective
date of the change of operator. Thereafter any quality incentive
payment shall be determined under division (C) of this section.
(G)
The intent of the general assembly, in amending this section, is to
clarify statutory language in response to the decision of the Ohio
Supreme Court in the case
State
ex rel. LeadingAge Ohio v. Ohio Dept. of Medicaid
,
Slip Opinion No. 2025-Ohio-3066 and to require the department to
continue calculating and paying the quality incentive payments in the
manner they were actually paid in state fiscal years 2024 and 2025.
The general assembly acknowledges that the department calculated the
quality incentive pool in the way the general assembly originally
intended.
Sec.
5165.36.
(A)
Beginning
with state fiscal year 2024, the department of medicaid shall conduct
a rebasing at least once every five state fiscal years. When the
department conducts the rebasing for a state fiscal year, it shall
conduct the rebasing for only the direct care and tax cost centers.
(B)
For each rebasing of the direct care cost center conducted on or
after the effective date of this amendment, the department shall
increase the amount of the quality incentive payment under section
5165.26 of the Revised Code by sixty per cent of the total increase
in estimated expenditures from the rebasing of the direct care cost
center, using the cost per case-mix unit determined under division
(C)(1)(b) of section 5165.19 of the Revised Code. The department
shall use the most recent calendar year cost report medicaid days
when estimating the total expenditures.
(C)
For each rebasing of the direct care cost center conducted on or
after the effective date of this amendment, the department shall
determine a percentage for each peer group's cost per case-mix unit
determined under section 5165.19 of the Revised Code that results in
a reduction in total estimated expenditures equal to the amount
determined under division (B) of this section.
Section
2.
That
existing sections 5165.06, 5165.151, 5165.158, 5165.19, 5165.26, and
5165.36 of the Revised Code are hereby repealed.