Bill > SB390

This bill makes several changes to the laws governing nursing facilities that participate in the Medicaid program, which is a government health insurance program for low-income individuals. A key provision introduces a five-year ban on new provider agreements for nursing facilities following a change in operator, unless an emergency situation necessitates an exception. The bill also revises how initial Medicaid payment rates are set for new nursing facilities, adjusting how direct care costs are calculated and introducing a new method for determining a new facility's case-mix score, which reflects the complexity of resident care needs. Additionally, it modifies the requirements and incentives for private rooms in nursing facilities, including specific criteria for approval and a new system for retaining eligibility for private room payments, which now requires facilities to maintain a certain overall rating on the Centers for Medicare & Medicaid Services (CMS) five-star quality rating system and participate in resident satisfaction surveys. The bill also updates the calculation of quality incentive payments, which are additional payments to facilities based on their quality metrics, by adjusting the points awarded for certain quality measures and increasing the overall pool of funds for these payments. Finally, it mandates that the Department of Medicaid conduct rebasing, which is a process of recalculating payment rates, at least every five years for direct care and tax cost centers, and specifies how the quality incentive payment amounts will be adjusted during these rebasing periods.

Budget and Finance

https://www.legislature.ohio.gov/legislation/136/sb390