11/20/2023

Private Rooms to be First-come, First-serve, ODM Confirms

Private Rooms to be First-come, First-serve, ODM Confirms

On Friday, LeadingAge Ohio met with officials from the Ohio Department of Medicaid to review a draft rule related to the forthcoming private room rate and discuss the process by which applications will be received.

Earlier this year, HB33 included $160 million in appropriations in FY 2025 for private room payments, to be made based on two categories of rooms:

• Category 1 rooms: $30 per day for private rooms with a private bath (toilet & sink)
• Category 2 rooms: $20 per day for private rooms with a bath shared with no more than one other person.

The funding for the private room payment is capped, and without certainty around how many private rooms are occupied by Medicaid residents, applications will be taken on a first-come, first-serve basis. The following are details discussed on the call:

• ODM will use the same survey tool for the applications as it used when it surveyed Ohio nursing homes earlier this year on whether they would freeze their case mix or continue to use the optional state assessment (OSA). Applications will be submitted by Medicaid provider number, which means multisite providers will need to submit a separate application for each nursing facility.
• ODM will open the application window at 8:00am on January 2.
• Applications will in in form and manner prescribed by the department, and will include a:
  • List of all rooms and their corresponding number of beds, designating the rooms for which private room incentive payment approval is requested and identifying which rooms are category one and category two private rooms as defined in section 5165.158 of the Revised Code.
  • Floor plan of the entire facility which identifies and shows the location of each private room with the designated room number and designated bathroom. Arrows should indicate the path between each resident room and the bathroom and each resident room and the hallway.
  • Documentation evidencing the private room meets the criteria in paragraph (C)(2) of section 5165.158 of the Revised Code.
  • Attestation in the form and manner prescribed by the department that the information submitted by the facility is accurate and truthful.
• The list of rooms and floor plan will be able to be uploaded with the application, and ODM will check this data against ODH licensure data.
• When calculating how to approve applications, ODM will presume that 50% of private rooms will be occupied by Medicaid residents during the year. Once it reaches the amount that would constitute the full appropriations, any subsequent applications would be waitlisted.

ODM noted that currently, it is only planning to hold a single application process, meaning that any future rounds of application, as well as future years of funding, would need to be dictated by the General Assembly. ODM shared a draft rule outlining the application process, noting that if the rule is regular-filed, it will not be effective before the date when applications are being considered for review. For this reason, ODM is considering pursuing emergency filing.

ODM is planning communications to providers in early December and mid-December with these as well as other details relevant to the application submissions. LeadingAge Ohio strongly encourages members to join tomorrow’s All-Member Call, when LeadingAge Ohio President / CEO Susan Wallace will provide an overview of the application process and recommendations for how each provider should prepare in order to ensure they are at the “front of the line” for the private room payment. Questions may be directed to Susan Wallace at swallace@leadingageohio.org.