The Ohio Department of Medicaid (ODM) has finalized the fiscal year 2019 (FY19) Medicaid rates effective 7/1/18 to 12/31/18.
- The statewide average 7/1/18 Medicaid rate was $195.95 which was an increase of $.80 from 1/1/18 and $1.54 from the statewide average 7/1/17 Medicaid rate.
- The biggest average increase was peer group 3-large at $1.40 while peer group 1-large had the only decrease at ($.14).
Average rates by peer group for the last 3 semi-annual periods are as follows:
- Rates for most facilities will be updated on 1/1/19 based on the June and September case mix scores.
- Amended Substitute House Bill 49 (HB 49) did not change the FY19 peer group prices but contained changes to the quality point system.
- HB49 expanded the quality incentive from five points to seven points by:
- Splitting the pressure ulcer and antipsychotic points into separate points for short-stay and long-stay residents
- Replacing the hospital admissions quality point, which could not previously be calculated, with an unplanned weight loss quality point.
- ODM was unable to accurately calculate the 2 antipsychotic measures for FY19, so all providers were awarded 2 points (one for long-stay and one for short-stay).
- For FY19, the average quality awarded was $1.91 with 66% of providers earning 5 points.
Breakdown of points earned by percent and number of facilities is as follows:
Contact your HW Healthcare advisor if you would like a breakdown of your Medicaid rate by component for 7/1/18 and 4 prior semi-annual periods.