The Ohio Department of Medicaid (ODM) has begun the process of issuing the long-awaited nursing facility QIP payments. Nursing facilities should have received a communication from ODM dated September 29 regarding these payments. The notice was sent to each facility’s PNM administrator and provides important information about the payment timeline and how facilities can access their individual payment amounts.
First-Round Payments Scheduled for October 2
ODM's notice states that first-round payments are scheduled to be issued October 2, 2026. A second round of payments is still pending CMS approval, with ODM anticipating that the approval process will take approximately another month.
For facilities that did not undergo a change of operator or change of ownership (CHOP/CHOW):
- ODM has developed a HB 479 NF Payments Dashboard showing each facility's payment amount.
- ODM states that the amounts displayed on the dashboard are the final payment amounts. These amounts may differ from amounts cited earlier this year. This is due to the recalculation conducted by ODM last week.
- Payments will be processed through separate payment cycles from regular claims payments.
- Payments will appear on the facility's electronic Remittance Advice (ERA) in the PNM secure portal.
- The payment will be identified as “HB479; 180 Ohio St.3d 41 2025.”
CHOP/CHOW Facilities
Facilities that underwent a change of operator or change of ownership between July 1, 2023, and March 20, 2026 have additional requirements before payment can be issued.
ODM states that:
- A notarized joint notice or agreement signed by both the exiting and entering operator/owner must be submitted to ODM.
- The document must identify the proper payees and indicate whether the payment will be divided between the entities and, if so, in what proportions.
- If a joint notice or agreement is impossible because the exiting operator or owner no longer exists, documentation proving that must be provided.
- ODM will contact entering and exiting operators in the coming weeks with instructions for submitting the required information.
- No payment will be made to a CHOP/CHOW facility until the required information has been provided.
Please send questions about the CHOP/CHOW process to Eli Faes at efaes@leadingageohio.org.
ODM's Payment Methodology
As previously reported, ODM changed its calculation methodology. Some providers may see a difference in the preliminary provider-level estimate provided by ODM. ODM recalculated the quality pool and rate components for each rate period from July 1, 2023, through March 31, 2026, and used Medicaid cost-report days to determine the amount payable to each facility. For most providers, the difference from the earlier estimate is expected to be less than 10%. However, some providers are seeing significantly larger changes. In particular, providers with higher levels of PA1, PA2 or ventilator days may see substantial decreases from their earlier estimates, while other providers may see increases.
Please Keep Us Informed
LeadingAge Ohio is aware that providers have begun receiving payment communications and that questions are arising as facilities review their information.
If you have not received the September 29 ODM communication, cannot access your payment information, believe there is an issue with your payment amount, or encounter another problem with the payment process, please email Eli Faes at efaes@leadingageohio.org.
Please forward the relevant ODM communication or other documentation, along with a brief description of the issue, so we can identify questions or trends and raise them with ODM as appropriate.
ODM's notice directs facilities with questions about the communication to NFRateSetting@medicaid.ohio.gov.
LeadingAge Ohio will continue to monitor the rollout of these payments and provide additional information as it becomes available.
