Medicaid weighs in on nursing home payments to improve patient care

The Biden administration is considering requiring the country’s 15,500 nursing homes to spend most of their contributions from Medicaid on direct care for the population and limit the amounts spent on operations, care and capital improvements, or for profit.

If adopted, it would be the first time the federal government has insisted that nursing homes devote the bulk of Medicaid dollars to caring for the population.

The strategy, which has not yet been officially proposed, is in between a few steps officials are considering that the COVID-19 pandemic has hit vulnerable nursing home residents particularly hard. Years the first 12 months of the pandemicat least 34% of those killed by the virus lived in nursing homes and other long-term care facilities, although the population of these facilities is less than 1% of the U.S. population.

Medicaid, the federal state’s health insurance program for low-income people, pays the bills for 62% of the long-term care population in a nursing home. In 2019, it amounted to 50.8 billion. Medicare, which includes short-term visits to nursing homes for the elderly or disabled, spent € 38.2 billion that year. (Officials did not include Medicare payments in the discussion on direct care costs.)

“Absolutely essential ingredient for good care” is enough staff to Dan TsaiDeputy Administrator and Medicaid Director of Medicare and Medicaid Service Centers said KHN.

The CMS has asked for public comments on a possible authorization for direct care costs, proposing to update the nursing home payment policy and rates for next year. Tsai also spoke about it at a meeting in Chicago in April with Illinois state officials, nursing home workers, residents and relatives.

Studies have shown a strong link between staff numbers and supervision. The CMS does not require a specific number of nurses and other staff, although some states do.

“We want to ensure that dollars enter the direct care workforce to ensure high quality care,” said Tsai KHN.

In order to receive a state salary, nursing homes must meet a number of requirements to ensure quality care. Violations can be punished. Purpose of federal research created that inspectors may not notice serious problems and that inspections do not consistently meet CMS standards. Infection control was one of the most frequent violations.

In its request for public comment, the CMS asked a number of questions, including: “Is there evidence that the resources that could be spent on staff are being used for costs that are not necessary for quality patient care?”

The federal interest follows laws have been passed in three states – Massachusetts, New Jersey and New York – order maintenance costs. Massachusetts requires nursing homes to spend at least 75% of their income on caring for residents. New Jersey nursing homes must spend at least 90% of Medicaid payments on caring for the population, and no more than 5% can be for profit. New York obliges at least 70% of nursing home income, including payments from Medicaid, Medicare and private insurance, to be used to care for the population and at least 40% of direct care money to be paid to ‘living’ workers. . Profits are limited to 5 percent. All three states promise to increase state Medicaid payments to institutions that comply with the law.

April National Academy of Sciences, Engineering and Medicine approved a strategy for direct care spending report on improving home care.

“When you use public dollars, those dollars should be returned to direct care,” he said. David Grabowski, Professor of Health Policy at Harvard Medical School and member of the committee that drafted the report. “We hope that the nursing home will best decide what part of the cost of labor, materials and capital would really be of the highest quality, but that was not the case. So this recommendation is definitely an opportunity to install guardrails.

National nursing home industry groups are opposed to such demands being made at a difficult time due to staff shortages in many institutions. In New York, two trade associations and about half of the state houses filed two lawsuits to block the state spending directive.

It is said that the staff in the nursing home is already “no. 1 “. Stephen HansThe president and CEO of the New York State Association of Health Institutions, which represents 350 nursing homes and led one of the lawsuits. “We’re a practical industry.”

The 239 nursing homes that joined the association’s lawsuit claim that if New York law had been in effect in 2019, the facilities would have been forced to provide an additional fee to residents. $ 824 million for direct care or return that amount to the State.

Hanse objects to the state telling nursing home administrators how to do their job. “For example, you could have an amazing nutrition program, and this law would oblige layoffs and hire front-line workers to meet the needs of workers,” he said.

The claimants claim that forcing the owners to spend more money on direct care leaves less money to maintain their premises and the quality of care will suffer. They also claim that Medicaid does not cover the cost of caring for the population. Defenders of the population say the facilities could hide their profits overpayment of related companies they own, for example, laundries or food service companies.

While the requirement to spend costs for nursing homes in three states is new, it has become commonplace for health insurers across the country. According to the Affordable Care Act “medical loss ratio“As a rule, health insurance companies must spend at least 80% of the premiums on the medical care of the beneficiaries. No more than 20% may be allocated to administrative expenses, executive remuneration, advertising and profits. Companies that exceed the limit must return the difference to the beneficiaries.

In addition to direct care spending authorization, Tsai said the CMS is interested in a slightly different approach to the state of Illinois that changed the rules for nursing homes this year. Her nursing home Tariff Reform Act increases Medicaid funding and then requires each house to hire at least 70% of the staff the population needs, according to a state analysis. The state then uses wage and other data to verify that the facility was compliant. If not, the difference will be deducted from the next payment.

“There are states across the country that are trying different methods to ensure that the dollars in the system’s reimbursement rates for nursing homes are actually – one way or another – actually allocated to high-quality staff,” Tsai said. “That’s our main goal.”

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