On April 26, 2023, the Ohio House of Representatives passed its version of the state budget, known as House Bill (HB) 33. The legislative language for HB33 is over 5000 pages long, but there are two documents prepared by the Legislative Service Commission which may be helpful to use when viewing changes to the programs: the appropriation spreadsheet and the comparison document.
The House made changes to some programs and funding for the Departments of Aging (ODA), Developmental Disabilities (DODD) and Medicaid (ODM). The following information is an overview about some of their programs and funding that could impact ODA, DODD and ODM’s operations to support Ohioans.
Individuals who would like to become home health aides or personal care aides in PASSPORT must fulfill eight hours of pre-service training.
Affected programs within ODA and DODD
There are some ODA and DODD programs to keep note of in the House passed version of the state budget. As we have written about previously, PASSPORT is a home and community-based waiver program that offers various services to older adults in their homes such as home-delivered meals and nutritional counseling. In the House passed version of HB33, individuals who would like to become home health aides or personal care aides in PASSPORT must fulfill eight hours of pre-service training. Likewise, to maintain eligibility, a home health aide or personal care aide must complete six hours of in-person training, over 12 months, that ODA accepts. Currently, in order for individuals to get certified in PASSPORT, they must complete at least 16 hours of classroom instruction and 16 hours of field experience, which is supervised. The House decreased funding from a line item for ODA to receive funding from the state to help operate PASSPORT and PACE, while the federal share for the programs remained the same.
The House increased provider wages for those who offer direct care services and other home and community-based services (HCBS). Under the ODA and DODD, providers who are serving older adults and people with disabilities will receive $17 per hour in FY2024 starting on January 1, 2024 and $18 per hour in FY2025. Presently, providers of direct care services and HCBS make around $12 an hour. Funding for Healthy Aging Grants and AGE Home and Community Based Services didn’t change in the new version of HB33. According to ODA Director Ursel McElroy’s testimony to Senate Health, Healthy Aging Grants are one-time grants created “to increase access to services and supports demonstrated to help aging adults stay healthy, live longer, and increase their independence in the community.”
Healthy Aging Grants and ARPA-funded AGE program
Some of the services that can be done from the Healthy Aging Grants include minor home modifications, transportation, chronic disease management, respite and nutrition services. However, the House added a provision in the new bill that Healthy Aging Grants will be sent to the board of county commissioners, or county executives and county council of a charter county in all counties, instead of local partners. Hence, there will hopefully be a successful streamlined process for Healthy Aging Grants to be dispersed toward services and programs. The AGE Home and Community Based Services are funds from the American Rescue Plan Act to enhance, expand or strengthen HCBS through IT system modifications and enhancements. By enhancing IT system modifications, this can improve workforce capacity and increase access to services.
Programs for nursing facilities will mostly remain the same.
Programs for nursing facilities will mostly remain the same, with a few changes. The Nursing Home Quality Initiative, provided by ODA, is a program which focuses on improving person-centered care in nursing homes. The office of the state long-term care ombudsman program will also help run this program. Through this program, there will be various quality improvement projects that provide resources and on-site education promoting person-centered care strategies in nursing facilities. As a new rule in the House version of HB33, some of the projects that ODA can offer are facility technical assistance and infection prevention and control. In addition, the House didn’t make funding changes for the Nursing Home Quality Initiative.
Nursing facility programs within ODM
Most nursing facility policy is determined in ODM’s budget. The line item, Medicaid Health Services, will experience slight increases in funds for FY2024 and FY2025. The funds are used to reimburse health care providers who provide services to Medicaid recipients and to make managed care capitation payments, generally. The expenses are specifically outlined through numerous categories such as hospital services, aging waivers, managed care plans and nursing facilities. There will be a 3.68 percent increase in FY2024 from the introduced version of the budget and a 4.38 percent increase in FY2025.
The House kept the amount of Medicaid payments allocated for nursing facilities at $415 million for each fiscal year.
The House kept the amount of Medicaid payments allocated for nursing facilities (called Medicaid Services- Long Term) at $415 million for each fiscal year. Furthermore, the House created a new rule about nursing facility private rooms’ payments. Starting in FY2024, ODM will establish a private room per day payment rate of 30 dollars as an incentive payment, which has been associated with higher resident and family satisfactions. ODM can increase the private room per day payment rate in FY2025.
Nursing home rebasing will also experience some changes according to the House version of the state budget. We have previously described that rebasing is a calculation which ensures that Medicaid payments for nursing homes are automatically inflated. The House increased the rebasing rate to at least every two years instead of every five years beginning in FY2024. In addition, the House imposed a limit in the nursing facility’s base rates in FY2024 and FY2025. Specifically, there will be a 40 percent limit increase for the direct care cost and ancillary and support. This means that direct care workers in nursing homes can possibly experience increases in their wages.
The state budget is currently in the Senate. We will continue to review these programs as the budget season continues.
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