02/19/2026

ODM Signals Swift Changes for Nursing Home Vent Services

The Ohio Department of Medicaid (ODM) outlined changes coming to nursing facilities that provide ventilator services, following concerns about billing practices misaligned with program intent.

During a stakeholder meeting on February 19, ODM shared that proposed rule changes will likely:

• Establish formal definitions for invasive and non-invasive ventilator modalities
  
• Require respiratory therapist staffing
  
• Implement prior authorization for complex non-invasive interventions
  
• Require annual reporting on provider-picked resident health outcomes
• Establish a new three-tier rate system, with BiPAP and CPAP receiving no reimbursement, complex non-invasive treatment reimbursed with a daily add-on rate, and invasive ventilation and vent weaning reimbursed under an enhanced rate.
  

The changes stem from state concerns that the ventilator program, originally designed to support residents with invasive ventilator needs, is being billed for less acute uses, including residents using BiPAP therapy.

LeadingAge Ohio learned of concerns with the ventilator program in late January and quickly convened members who provide these services. Drawing on member expertise, LeadingAge Ohio submitted recommendations to ODM focused on program integrity and appropriate care. ODM plans to include recommendations, such as respiratory therapy staffing, in its rule change. Other recommendations were discussed with the stakeholders on the call. 

What’s next

ODM is sending a survey to providers participating in the vent program within the next week. After reviewing survey results, ODM will issue the proposed rules for public comment. LeadingAge Ohio will continue to engage with the department and keep members informed as additional details become available.