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Late day on Monday, Governor DeWine released the “blue book” and fact sheets that include some details about what would be contained in the Executive Budget. The legislative language will not be released until next week at the earliest, at which point the details of the proposals will become clearer. The bill touts $1 billion in investment towards coronavirus recovery, which includes supports for local health departments and businesses impacted by the pandemic.
Included in the budget were numerous changes pertaining to nursing homes, which preserve existing funding levels and create new investments for those impacted by the pandemic and those that demonstrate quality care. Another proposal would give the Director of Health more authority to act when an individual’s health or safety is in danger due to substandard care.
LeadingAge Ohio is still learning details on budget impacts for Ohio’s home- and community-based providers, including personal care services and adult day provided under PASSPORT and assisted living provided under Ohio’s assisted living waiver.
The proposals include the following:
- Invest $50 million for a nursing home reform initiative in response to the underutilization of licensed nursing home beds in Ohio. The Department of Health, in collaboration with the Department of Aging and Medicaid, will launch a reform initiative to encourage facilities to voluntarily downsize, move to single patient rooms, and remove the costly excess unused beds from the system. The way the nursing home payment structure in Ohio was designed years ago, Medicaid is required to cover a portion of expenses for unused bed days. According to current Department of Health records, nearly 20% (approximately 11,000) of eligible nursing home beds were vacant prior to the start of the COVID-19 pandemic; occupancy has weakened significantly since its start. As Ohioans demand more community-based care options, this initiative will help rebalance the services available and improve the quality of care for all Ohioans, regardless of setting.
- Increase the authority and ability of the Department of Health to protect nursing home patients from dangerous situations. The Patient Protection proposal would give the Department of Health the authority to swiftly intervene to protect patients in nursing facilities when they determine the safety of patients is in jeopardy. If needed, the Department will have the authority to immediately remove patients and relocate them into a safe facility.
- Launch new training opportunities through the Department of Aging. The Training and Improving Ohio Nursing Facilities proposal will launch a series of new quality improvement initiatives and a technical assistance programs to improve the quality of care across the board for Ohio nursing homes. Programming will be targeted to address infection control, elder abuse, and other areas that are flagged as prominent during the Department of Health's inspection process.
- Invest $440 million into quality outcome incentives for Medicaid nursing home services. The Quality Driven Reimbursement proposal seeks an increase of $100 million into a new payment formula that moves to reward nursing homes for providing high-quality care, based on meaningful outcome-driven industry leading metrics. The Department of Medicaid will work in collaboration with a joint committee and seek input from experts across multiple agencies, providers, and senior advocates to ensure a robust and high-quality incentive-based payment structure. Additionally, to encourage high quality oversight, recipients will be required to ensure that key nursing home staff such as an administrator, medical director, nursing director, and quality improvement director reside in and work in the state of Ohio.
The $440 million reflects both the continuation of the investment made in the quality incentive payment during SFR 2020-21 budget, as well as an additional $100 million to expand the portion of the reimbursement formula incentivizing quality care. Other changes that were not included in the budget preview, but were shared with LeadingAge Ohio by Administration leadership, include delaying rebasing and providing some regulatory relief by extending the licensure survey interval for providers with consistently high survey performance.
Other proposed changes likely to affect LeadingAge Ohio members include several managed care provisions:
- The Department will ease the claims and reimbursement timeline by implementing a fiscal intermediary to serve as the front door to submissions.
- The Department will centralize provider credentialing, eliminating redundancies embedded in the program today due to this function being managed by each of the six MCOs.
- The Department will simplify and standardize Medicaid’s preferred drug list to eliminate the need for providers to understand and comply with six individual preferred drug lists managed by MCOs.
LeadingAge Ohio urges caution, as the documents released today are only the first view of the executive budget, with very little detail provided. The full budget language is anticipated next week, at which point LeadingAge Ohio’s policy team will closely examine and communicate the details of each proposal. Furthermore, the Executive Budget is only the first step in what will be a five-month long legislative process, as the budget bill passes through the House, Senate, conference committee and ultimately, back to the Governor’s desk for signature.
Throughout the budget process, members are encouraged to dial in to the LeadingAge Ohio Advocacy in Action calls on the second and fourth Monday of the month at 10am. The calls will feature the latest from the Ohio Statehouse related to various aging services proposals.
Advocacy questions may be directed to Susan Wallace, Chief Policy Officer, at swallace@leadingageohio.org.
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