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CMS cuts Medicare funding for nursing homes

Nearly two weeks after Medicare and Medicaid Service Centers (CMS) announced a 4.6% cut in the patient-driven payment model, administrator Chiquita Brooks-LaSure doubled the schedule for these cuts by to the industry, saying the agency’s hands are effectively tied.

“I would say we have statutory obligations and there are rules within what Congress does for us as to how we set rates and this is one that is really required given the trajectory,” Brooks-LaSure told Skilled Nursing News in an exclusive interview.

CMS, in its proposed SNF Potential Payment System rule, recommended a 3.9%, or $ 1.4 billion, increase in payment to the industry.

The government agency has said it is “imperative” to act in a timely manner once overpayments are identified, in accordance with the proposed rule published in the federal registry.

The government agency also considered a proposal to adjust SNF’s down payment rates by 4.6%, or $ 1.7 million, to achieve budget neutrality. This represents a decrease of approximately $ 320 million in Medicare Part A payments to SNFs in fiscal year 2023 compared to the previous fiscal year.

“We really want to work with the industry to continue to make sure they get the right funding. That’s really our approach, right, we really see all of these issues in a holistic way,” he told SNN.

His comments came just hours after CMS introduced a new database on the ownership of hospitals and nursing homes, with the aim of providing more transparency to health care and informing policy decisions in the future. .

Brooks-LaSure told reporters after a roundtable discussion with nursing home workers, advocates and state and federal officials that the amount of turnover, both in terms of staffing and ownership in the nursing home industry. grandparents, it was especially troubling.

Between 2016 and 2021, 3,236 SNFs were sold, equivalent to 39.9 per 1,000 SNFs per year, according to the data.

“That’s one of the reasons we’re launching the transparency piece we’re launching today, making sure the money is being spent well. This is really one of our areas of focus and we really want to hear how it’s going. they spend those dollars and what can we do differently, “Brooks-LaSure told SNN.

Also on the issue of transparency, CMS Senior Deputy CEO and COO Jonathan Blum said the COVID-19 pandemic has shown that the CMS approach is likely to need to be refocused.

“We need to focus more on where we have the greatest risk of harm to the patient. We need to focus more on helping to support the facilities, to support the workers who are trying to better care for their patients,” he said. Blum to journalists.

Link Medicaid reimbursement to staffing measures

As CMS closely monitors states such as Illinois and New York, which have linked funding to staffing measures, the agency is considering doing the same at the federal level.

Illinois House Bill 246, which would raise $ 700 million in funding for nursing homes in the state, was passed by the legislature earlier this month.

Facilities should meet at least 70% of the federal staffing level guidelines to obtain a bonus refund; payment is based on your CMS quality star rating.

New York also passed legislation that went into effect on April 1, stipulating that 70% of a nursing home’s income will go to direct care for residents and at least 40% to endowment. staff.

At the federal level, as part of the rule proposed by the SNF in light of Biden administration reforms, CMS requested input from stakeholders on a measure that would examine staff turnover levels. to nursing homes to potentially include them in their SNF value-based (VBP) purchases. ) program.

Currently, the program is designed to improve patient outcomes by providing financial incentives or penalties based on 30-day hospital readmission rates. VBP sets a baseline for performance and improvement for SNFs to comply to avoid a penalty.

“As we see states are really thinking about how they can make sure they pay for value … that’s something we really want to work with on the Medicaid side, and I’d say we’re still looking for ways to do that. that the dollar is spending well, “Brooks-LaSure told SNN.

Daniel Tsai, deputy administrator and director of the Medicaid and CHIP Service Center, said the agency is considering setting minimum standards for nursing home owners when it comes to spending Medicaid reimbursement funds on direct care.

“We are contemplating and looking forward to discussing how we could create transparency or standards so that a minimum amount of reimbursement really flows to the direct care workforce compared to all sorts of other things,” Tsai told reporters.

“That would be something we’re looking at that would be a nationwide framework for Medicaid,” he added.

Staff remain at the heart of the conversation

Brooks-LaSure said in its ongoing conversations with various stakeholders over the past few months, staff remain at the center of the conversation.

CMS in its proposed rule specifically called for stakeholder feedback to help the agency set minimum staffing requirements as part of Biden’s nursing home reforms.

Feedback, CMS said, will be used in conjunction with an ongoing research study to determine the optimal level and type of staffing needs for a nursing home.

CMS intends to issue proposed rules on a minimum staffing requirement within one year of Biden’s State of the Union address.

“When we think about quality, what we’ve heard over and over again is staffing, and we’ve heard it from residents, speaking directly to them, we’ve heard it from staff,” he told SNN.

However, many in the industry are scratching their heads at the time of the proposal, how it will be paid and where the workers will come from, at a time when potential candidates are scarce.

Since the beginning of the pandemic, the skilled nursing industry has lost 241,000 workers, or 15.2% of its total workforce.

Brooks-LaSure said the agency will first prioritize more transparency over how existing federal dollars are being spent.

“So I think one of the things you’re listening to in this conversation is that we have a better idea of ​​where the dollars are going,” he told reporters. “So I would say this is where we start with more transparency, and we’ve talked about some of the things we’re doing, but moving in additional directions to make sure the dollars that are being spent will go to direct attention. ”

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