The Ohio Department of Medicaid (ODM) has finalized the fiscal year 2021 (FY21) Medicaid rates for Ohio nursing facilities, effective 7/1/2020 to 12/31/2020. The statewide average 7/1/2020 Medicaid rate was $209.14, which was an increase of $6.54 (3.2%) from the 1/1/2020 statewide average rate of $202.60.
Rate changes were primarily comprised of the semi-annual, case-mix adjustment using the average of the December 31, 2019, and March 31, 2020, Medicaid case-mix scores and the recalculation of both the old and new quality incentive payments.
As always, the updated rates will impact payments from both traditional Medicaid and MyCare Ohio Medicaid. Though ODM is putting additional pressure on the MyCare plans to accurately update the rates, be sure to review your MyCare payments carefully, as the MyCare plans have had significant issues in the past.
Review your rate package for accuracy
Rate packages are available in MITS. It is important that you review these calculations closely for possible errors, as there is a tight timeframe for filing rate reconsideration requests. We have identified several ODM errors particularly related to the new quality occupancy provision. Contact us if you need assistance.
New Quality Points Summary (ORC 5125.26)
The average new quality incentive increased to $9.58 from $5.32. This was primarily due to increased value per quality point of $.85, up from $.40, as a result of the additional funding provided by HB481. The average points earned decreased to 11.27 from 13.31. However, the number of facilities earning 16 or more points increased 11%.
Effective 7/1/2020, facilities that are less than 80% occupied and earn less than 15 quality points are not eligible to receive the new quality payment. There were 227 providers that did not receive a quality payment due to the new occupancy provision, change of ownership, or being a newly opened facility. The new quality payment is effective for all of FY21. HB481 ends this new quality points system at 6/30/2021.
The following charts provide more details on average points and number of facilities earning points:
Old Quality Points Summary
The average old quality payment is $1.91 for FY21. Each quality point is worth $.52, up from $.42, with a maximum of 7 points awarded. All providers were awarded the satisfaction survey point, since the resident satisfaction survey was not completed due to COVID-19.
The following chart provides more details on the number of facilities earning each point:
How can we help?
Please contact us for assistance with any of the following:
- Reviewing your July 1, 2020, Medicaid rate
- Filing a rate reconsideration
- Detailed Medicaid rate history, case-mix, and quality analysis
- Benchmarking expenses, census and staffing against selected competitors, as well as county, peer group and statewide averages
- Accounts receivable aging review
- Any other reimbursement, revenue cycle, accounting or tax needs
