11/20/2025

Legislature Finalizes Prospective Change to Nursing Facility Quality Payment Formula

Ohio lawmakers advanced a budget corrections measure this week that cements a forward-looking change to the nursing facility quality incentive payment formula, confirming that the interpretation used by the Ohio Department of Medicaid will govern future payments despite the Ohio Supreme Court’s ruling in State ex rel. LeadingAge Ohio v. Ohio Department of Medicaid. The change was enacted through an omnibus amendment to House Bill 184, which passed both chambers Wednesday evening.

The amendment replaces the current reference to a “rate” with “cost per case mix unit,” a statutory adjustment that allows the Department to continue using its  interpretation rather than the Court-affirmed method. As enacted, the revised language applies only to payments made once the bill takes effect—90 days after the Governor’s signature. The Supreme Court’s interpretation remains in force for state fiscal year 2024, state fiscal year 2025, and for the period between July 1, 2025, and the statute’s implementation.

During Senate Finance Committee deliberations, Chair Jerry Cirino reiterated that the change is entirely prospective, emphasizing that it does not resolve the substantial underpayments recognized by the Court. Chair Cirino stated that “nothing retroactive” is included in the bill, echoing his earlier remarks that the amendment clarifies what lawmakers intended during the last General Assembly regarding the quality pool calculation.

The Senate’s floor discussion reflected unease among several lawmakers about both the speed of the process and the potential impact on providers. Senator Al Cutrona cast the single opposing vote, questioning the lack of deliberation. Senator George Lang supported the measure but reported that some nursing facilities fear significant financial consequences and noted the difficulty of assessing those concerns with limited review time.

In the House, members concurred with the Senate changes by a wide margin. Representative Brian Stewart, the bill’s primary sponsor, stated that nursing facilities will receive the payments identified by the Court but contended that focusing solely on the ruling overlooks broader Medicaid budget considerations. Representative Munira Abdullahi raised procedural concerns, criticizing the late addition of multiple provisions to the bill.

With legislative activity concluded for the year, LeadingAge Ohio will meet with the Ohio Department of Medicaid to review the implications of the prospective change and to ensure members have clear guidance on next steps. Additional updates will be provided as more information becomes available.