Issue 17 | April 2021
LeadingAge Ohio is pleased to share with you our legislative newsletter - The Aging Advocate. This monthly publication is designed to communicate what's going on in the world of aging and give you a peek at LeadingAge Ohio's 400+ members around the state. 
What's Inside?
  • House budget: Winners & what's next
  • Rebasing: What is it, and why is it so important to aging services?
  • Legislators visit McGregor PACE to learn about innovative care model
  • LeadingAge lobby day offers chance to connect with federal lawmakers
  • And more!
Aging Happenings
House budget: Winners & what's next

The Ohio House passed its version of the state budget bill last week. After over a year of fighting the coronavirus tooth-and-nail, Ohio's aging services providers found that some of their biggest pressure points were addressed by the House. Support came in the form of quality incentive payment (QIP) dollars, partially re-instituting rebasing, and support for adult day, but questions remain as the bill heads to the Ohio Senate.
Winners: Adult day, nursing homes qualifying for QIP dollars
LeadingAge Ohio's efforts to keep adult day in Ohio afloat were heard, and the House supported a $5 million-per-year boost to Ohio’s adult day providers through the PASSPORT program. Many adult day providers still remain shuttered as a result of the pandemic and the difficulty associated with re-opening under strict guidelines. Without this boost, Ohio risks substantial closures of adult day centers statewide. Without adult day, Ohioans move to costlier care options.
The House also improved upon the executive budget proposal to sustain the existing QIP. While the executive budget proposed a $360 million investment, and boosted funding by $50 million per year of the biennium, the House moved the language back into the permanent Revised Code, and increased the $360 million QIP investment by $58.5 million per year of the biennium, for a total of an additional $108.5 million per year. 
Needs Work: Rebasing, HCBS
Ohio’s long-term care facilities are currently reimbursed based on a formula derived from 2014 cost reports. Ohio statute requires the formula to be recalibrated, or “rebased,” every five years to ensure payment doesn’t drift too far below costs; per statute, rebasing is scheduled to occur for the SFY 2022 Medicaid rates. The Executive budget delayed rebasing for two years. While the House indicated rebasing should go forward by June 30, 2022, it only partially funded it ($50 million per year of the biennium.) 
Boosting funding for rebasing in full, by $150 million for each year of the biennium and requiring it be implemented no later than October 1, 2021, is crucial. Without rebasing, many Ohio long-term care providers serving rural or under-served regions will struggle to serve Ohioans in need of care. Rebasing is the safety net the sector relies upon.
Home- and community-based services provide care to Ohioans choosing to age at home as opposed to in a facility. The Executive and House budget increased nursing and aide payments by 4% for PASSPORT, Ohio Home Care Waiver, MyCare Ohio and assisted living. While this is an improvement, a 5% increase would provide a more meaningful boost to these vital services.
On to the Senate
With the House passage, it is now up to the Ohio Senate. LeadingAge Ohio has prepared a budget briefing that details the changes required to support Ohio's aging services providers. Between the devastation of the pandemic and the fast upcoming surge in the number of seniors needing care, it has never been more important to get this right. 
Rebasing: What is it, and why is it so important to aging services?
Many Ohio skilled nursing facilities feel on the defensive when it comes to the state’s Medicaid rates, given the ongoing workforce crisis, the rising number of older adults needing care in Ohio, and the challenges of the pandemic. Cost control, particularly for nonprofits, is a never-ending struggle.

The safety net that helps these organizations serve Ohioans is "rebasing" - or setting a new base level for the state's Medicaid rates. Rebasing is statutorily-required to occur by the Department of Medicaid every five years, per Section 5165.36 of the Ohio Revised Code. Ohio providers are currently reimbursed at 2014 cost report levels. Rebasing would bring them in line with 2019 costs, based on the most recent Medicaid cost report data available.

While much lip service is paid to quality-based payment, when you look at drivers of quality in nursing homes, research demonstrates that the more care a nursing home provides via the Medicaid program, the more it will struggle to achieve high quality measures. This is because typical nursing homes lose between $20 and $80 dollars per day for each Medicaid patient day, as costs far outpace payments. They are forced to contain costs using mechanisms that are available to them, including cutting staffing. Low staffing makes achieving high quality marks a challenge, so a downward spiral starts. In this way, fully funding rebasing is one of the most impactful steps available to boost quality. 

The Administration proposed delaying rebasing for two years - a "kicking the can down the road" approach which will only lead to a larger bill for the state to pay later on. The House indicated it should go forward by June 30, 2022, but only partially funded it ($50 million per year of the biennium.) Rebasing should occur in full, with an additional $150 million for each year of the biennium and the requirement that it be implemented no later than October 1, 2021. Ohio seniors and caregivers will suffer without it. 
Legislators visit McGregor PACE to learn more about innovative care model
Earlier this month, LeadingAge Ohio member McGregor PACE in Cuyahoga County welcomed Senator Matt Dolan, Senator Jerry Cirino, and Senate Minority Leader Kenny Yuko for a visit to learn more about the innovative Program for All-Inclusive Care for the Elderly (PACE). PACE provides comprehensive medical and social services to certain frail, elderly people (participants) living in the community. The vast majority of Ohioans who are in PACE are dually eligible for both Medicare and Medicaid.

PACE is a managed care model, but offers so much more than traditional managed care. The program provides all needed health care, medical care, and ancillary services across all settings. Services include primary and specialty care, adult day health services, personal care services, inpatient hospital care, prescription drugs, occupational/physical therapies, and nursing home care, offered through an interdisciplinary team responsible for coordination of 24-hour care delivery. This hands-on approach also assists in preventing abuse and enhancing social supports.

This model saves taxpayer dollars and provides quality care to nursing home eligible Ohioans reliant on state support. Aging experts agree: now is the time to replicate the PACE model in other areas of Ohio. To learn more about PACE and efforts to expand access to PACE in Ohio, check out this two-page briefing.
LeadingAge lobby day offers chance to connect with federal lawmakers
On Wednesday, April 21, LeadingAge Ohio members and staff joined LeadingAge (national) for its annual Lobby Day. While this is normally an opportunity to connect members with federal legislators on Capitol Hill, this year's Lobby Day, like so many other events, was held virtually. That didn't stop members from campaigning hard for increased COVID relief dollars and workforce supports from the federal government.

Members took part in 14 visits with members of the Ohio Congressional delegation, as well as 4 visits held with West Virginia legislators to ensure that LeadingAge Ohio members serving "across the border" covered all bases. Thank you, in particular, to Congressmen Steve Chabot and Troy Balderson for joining in person and having such thoughtful conversations with providers from the district.
About LeadingAge Ohio
Founded in 1937, LeadingAge Ohio is a nonprofit trade association that represents over 400 long-term care organizations and hospices, as well as those providing ancillary health care and housing services, in more than 150 Ohio towns and cities. The continuum of care reflected by the member organizations serve an estimated 400,000 elderly Ohioans daily and employ more than 35,000 persons statewide.

Want to meet with LeadingAge Ohio? Share a story? Visit a provider in your community?