This week, LeadingAge Ohio learned that the Department of Medicaid will be issuing guidance clarifying the implementation of the transition to the patient-driven payment model (PDPM) for calculation of the case mix factor applied in the Medicaid payment formula for nursing homes. Specifically, Medicaid will be clarifying the implementation dates for each phase of the transition.
HB96 states that:
“In fiscal year 2027, the increase or decrease to a nursing facility's direct care rate shall be two-thirds of the difference between the direct care rate on January 1, 2025, and the direct care rate determined utilizing case mix scores calculated in accordance with section 5165.192 of the Revised Code. Thereafter, a nursing facility's direct care rate shall be determined utilizing case mix scores calculated in accordance with section 5165.192 of the Revised Code.”
The point in question is whether “thereafter” refers to fiscal year 2028, or if it could refer to the January 1, 2028 ratesetting, which is after the beginning of fiscal year 2027. LeadingAge Ohio will include the guidance in forthcoming editions of The Source. Questions regarding this may be sent to Susan Wallace at swallace@leadingageohio.org.