The bill amends the Revised Code to introduce new regulations and payment structures for nursing facilities within the Medicaid program. A key provision is the establishment of section 5165.061, which makes operators ineligible to enter into provider agreements for five years following a change of operator, unless an emergency is declared by the Department of Medicaid. The bill also modifies the payment rate structure for new nursing facilities, detailing how initial rates for various costs—such as ancillary, capital, direct care, and tax costs—will be calculated based on peer group benchmarks and case-mix scores. Additionally, it introduces a private room incentive payment system that offers extra daily payments for certain private rooms starting in fiscal year 2024, contingent on facilities meeting specific quality ratings and compliance criteria.

Moreover, the legislation reclassifies nursing facilities into peer groups and alters the methodology for calculating the cost per case-mix unit, requiring the Department of Medicaid to conduct a rebasing every five state fiscal years. It includes a reduction in the total cost per case-mix unit for fiscal years 2027 and 2028, aimed at reducing Medicaid expenditures by $142 million over those years. The bill also outlines the calculation of quality incentive payments based on performance metrics from the Centers for Medicare and Medicaid Services (CMS) and repeals several existing sections of the Revised Code, indicating a comprehensive overhaul of the regulations governing nursing facility payments and quality assessments.

Statutes affected:
As Introduced: 5165.06, 5165.151, 5165.158, 5165.19, 5165.26, 5165.36