CMS calls on states to tie Medicaid payments to quality measures for nursing homes

The Facilities for Medicare & Medicaid Companies is asking states to make use of Medicaid funds to incentivize higher outcomes for nursing dwelling residents and enhance staffing.

CMS issued a bulletin on Monday detailing actions states can take to enhance care in nursing houses. The initiatives outlined might be carried out instantly via the Medicaid state plan, waiver or demonstration course of. These embrace making a minimal nursing dwelling staffing requirement, lowering resident room crowding, strengthening the Medicare Expert Nursing Facility Worth-based Buying program, and reinforcing the safeguards towards pointless medicines and coverings.

The bulletin builds on a set of reforms the Biden administration introduced in February.

“Our family members dwelling in nursing houses deserve the very best high quality of care, dignity, and respect,” stated Well being and Human Companies Secretary Xavier Becerra in a information launch. “At HHS, we’re taking one other essential step to implement President Biden’s daring set of reforms to enhance our nation’s nursing houses. We name on all states to work with us and guarantee everybody has entry to the high-quality care they deserve.”

Some states have already carried out applications that tie Medicaid funds to high quality measures, in response to CMS’ bulletin. This consists of California, which offers elevated funds to amenities that enhance the standard of care to their residents. They reward amenities that carry out at or above the state common, and assess them utilizing high quality indicators outlined by CMS.

One other state is Illinois, which created a data-driven staffing ratio goal program and wage incentive in 2022. This system helps amenities that enhance and preserve the wages of Licensed Nursing Assistants to enhance retention. This in return results in higher outcomes for residents, CMS stated within the report.

“We all know that low wages for workers can contribute to frequent turnover and harmful staffing shortages at nursing houses, so we encourage states to work with these amenities to search out options for coaching and bettering staffing,” stated CMS Administrator Chiquita Brooks-LaSure.

The company additionally beneficial that states use federal and state knowledge to enhance the oversight of nursing amenities. Some states do that utilizing the CMS Nursing Dwelling 5-Star High quality Score System. On this mannequin, states are ranked between one and 5 stars, the place 5 stars is taken into account above common and one star is under common.

Moreover, CMS known as on states to make use of state-specific knowledge to assist discover areas the place staffing might be improved and develop options. For instance, Connecticut created a 2% Medicaid charge enhance for amenities that elevate worker wages and salaries, enhance well being/dental advantages or retirement plans, or do a mix.

Lastly, following Covid-19, it requested states to assessment their emergency preparedness insurance policies and incentivize amenities to be extra ready for future pandemics. Nonetheless, it couldn’t present any examples of states doing this at present.

Whereas CMS’ announcement is a step in the precise route, extra must be carried out, together with totally funding nursing houses via Medicaid for the precise price of care, stated the American Well being Care Affiliation/Nationwide Heart for Assisted Dwelling.

“We respect CMS’ announcement in the present day — we have now lengthy backed reimbursement applications that assist and incentivize long run care suppliers to additional improve the standard of care delivered,” stated Holly Harmon, senior vice chairman of high quality, regulatory & medical companies at AHCA/NCAL. “Initially, Medicaid wants to completely fund nursing houses for the precise price it takes to take care of residents. Too many states fail to fulfill this baseline, and consequently, nursing houses are struggling to compete for staff and maintain their doorways open. We sit up for working with state and federal policymakers to proceed to develop these quality-focused reimbursement applications.”

Picture credit score: Drazen Zigic, Getty Photographs

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