The Ohio Department of Medicaid (ODM) provided LeadingAge Ohio, the Ohio Health Care Association and the Academy of Senior Health Sciences with a long-awaited update this week on the distribution of Quality Incentive Payment (QIP) dollars owed to nursing facilities following last year's Ohio Supreme Court mandamus decision.
ODM said the department is actively preparing for distribution while awaiting final guidance from the Centers for Medicare & Medicaid Services (CMS) on how the payments should be made. Department officials said they remain confident CMS will approve the federal matching funds, which represent approximately 65% of the total payment.
The remaining question is how the payments will be distributed. ODM's preference is to issue a single lump-sum payment directly to providers. The alternative would require routing payments through managed care organizations, a significantly more complex process because Ohio has since reprocured its managed care contracts, meaning some plans involved during the affected period are no longer under contract with the state.
ODM has completed preliminary payment calculations and will provide provider-specific data to the associations for review before any payments are issued. The department said the review is intended to identify potential discrepancies and ensure payment calculations are accurate before distributions move forward. Associations will have an opportunity to provide feedback, although the preliminary provider-level data may not be shared with members. ODM also plans to schedule a follow-up meeting after that review.
The department is simultaneously developing a process for facilities that experienced a change of ownership during the affected period, including an online portal to collect the information necessary to determine the appropriate payment recipient.
LeadingAge Ohio also asked how hospice pass-through payments will be handled, noting that hospice providers have already begun receiving questions from nursing facility partners. ODM said it is reviewing that issue and will provide additional guidance.
While no payment timeline was announced, ODM emphasized that it is completing as much of the preparatory work as possible while awaiting CMS direction so distributions can move forward quickly once federal approval is received.
LeadingAge Ohio will continue working closely with ODM throughout the process and will share additional information as it becomes available. Members with questions may contact Eli Faes at efaes@leadingageohio.org.