The Centers for Medicare & Medicaid Services requires states to use Medicaid payments to drive better outcomes for nursing home residents and improve staffing.
CMS issued a newsletter on Monday detailing actions states can take to improve nursing home care. The outlined initiatives can be implemented immediately through the state Medicaid plan, waiver or demonstration process. These include creating a minimum staffing requirement in nursing homes, reducing overcrowding, strengthening the Medicare Skilled Nursing Facility value-based purchasing program, and strengthening safeguards against unnecessary drugs and treatments.
The bulletin builds on a set of reforms announced by the Biden administration in February.
“Our loved ones living in nursing homes deserve the highest quality of care, dignity and respect,” Health and Human Services Secretary Xavier Becerra said in news release. “At HHS, we are taking another important step to implement President Biden’s bold set of reforms to improve our nation’s nursing homes. We call on all countries to work with us and ensure that everyone has access to the high-quality care they deserve.”
Some states have already implemented programs that tie Medicaid payments to quality measures, according to a CMS bulletin. This includes California, which provides increased payments to facilities that improve the quality of care for their residents. They reward facilities that perform at or above the state average and rate them using quality metrics set by CMS.
Another state is Illinois, which created a data-driven target staffing ratio and salary incentive program in 2022. The program supports facilities that increase and maintain the salaries of certified nursing assistants to improve retention. That, in turn, leads to better outcomes for residents, the CMS report said.
“We know that low staff wages can contribute to high turnover and dangerous understaffing in nursing homes, so we encourage states to work with these facilities to find solutions for staff training and improvement,” said CMS Administrator Chiquita Brooks-LaSure.
The agency also recommended that states use federal and state data to improve oversight of medical facilities. Some countries do this with the help of CMS Nursing Home Five Star Quality Rating System. In this model, countries are ranked between one and five stars, where five stars are considered above average and one star is below average.
In addition, CMS urged states to use state-specific data to help identify areas where staffing can be improved and to develop solutions. For example, Connecticut created a 2 percent Medicaid rate increase for facilities that increase employee wages and salaries, improve health/dental benefits or pension plans, or do a combination.
Finally, in the wake of Covid-19, he asked states to review their emergency preparedness policies and incentivize facilities to be more prepared for future pandemics. However, he could not provide any examples of countries currently doing this.
While the CMS announcement is a step in the right direction, more needs to be done, including fully funding nursing homes through Medicaid for the actual cost of care, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said.
“We appreciate today’s announcement from CMS—we have long supported reimbursement programs that support and incentivize long-term care providers to further improve the quality of care provided,” said Holly Harmon, senior vice president of quality, regulatory and clinical services at AHCA/ NCAL. “First and foremost, Medicaid should fully fund nursing homes for the actual costs necessary to care for the residents. Too many states fail to meet this baseline, and as a result, nursing homes struggle to compete for workers and keep their doors open. We look forward to working with state and federal policymakers to continue to develop these quality-focused reimbursement programs.
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