Terry Moore, Chief, Rate Setting Section, Ohio Department of Medicaid (ODM), reported late today that ODM has finalized the July 1, 2016 rates. As LeadingAge Ohio had noted earlier, ODM had difficulties with the Nursing Home (NH) Compare data for the two (2) MDS-based measures – antipsychotics and pressure ulcers. Specifically, ODM was struggling with how to handle those providers with blank scores (because of insufficient data) and how to deal with a measurement period in rule (two quarters ending 12/31/15) that differs from CMS’ NH Compare website (three quarters ending 12/31/15).
LeadingAge Ohio offered ODM some recommendations (with thanks to member/partner, Stephanie DeWees, Squared Business Solutions for assistance on our response). Ms. Moore shared that after much discussion and analysis, ODM has determined the NF quality measures (antipsychotics and pressure ulcers) as follows:
Effectively, ODM gave providers that had a blank score credit for meeting the long or short term measure. To be awarded a quality point, providers needed to meet the criteria in step 5.
As a result:
The remaining 23 NF providers (i.e. CHOPs and new) will receive the average quality payment rate of $0.58 per quality point and an average quality payment rate of $1.85.
Due to these calculations, more providers will be receiving more points than previously projected, however, this has resulted in each quality point being worth less, $0.58 versus $0.82. ODM has not provided information on when providers will be able to access their facility specific July 1, 2016 final rates.
LeadingAge Ohio will stay close to the release of the information and update our members. For questions, please contact Nisha Hammel, Director of Advocacy, nhammel@leadingageohio.org or Kathryn Brod, President/CEO, kbrod@leadingageohio.org.