rooms play in infection control strategies , as well as the costs and strategies needed to redesign nursing homes to prevent and contain COVID and other novel infectious diseases .”
It is proposed that these action steps would be funded by Medicaid payment policy .
The Care For Our Seniors Act represents meaningful change that requires significant funding . As AHCA / LeadingAge emphasize , “ Real , long-lasting transformation that will truly protect residents requires a considerable investment in the LTC profession . Long-term care providers stand ready to make meaningful change that can help our residents , our staff and our country . But it won ’ t be possible without a commitment from policymakers to provide the necessary and consistent financial support for our elderly residents . For too long , nursing homes have faced chronic Medicaid underfunding and unfunded government mandates , leaving many unable to afford enhancements in their care delivery , workforce and infrastructure . COVID-19 has exacerbated these economic challenges . Nursing homes have spent tens of billions responding to the pandemic specifically PPE , testing , additional staff and bonus pay . Coupled with significant losses due to fewer new residents , the nursing home industry expects to lose $ 94 billion over the course of the pandemic ( 2020-2021 ). As a healthcare provider that relies almost entirely on government reimbursement ( Medicare and Medicaid ), nursing homes cannot make substantial reforms on their own . They need the support of federal and state policymakers and resources .”
AHCA and LeadingAge have developed four interrelated , investment strategies that will help ensure a robust and quality long-term care system :
• Enhanced Federal Medical Assistance Percentages ( EFMAP ): Increased federal Medicaid funds are provided to states to pay for the mandatory nursing facility benefit , with requirements that additional federal funds be used for nursing facility rates .
• Federal framework for “ allowable cost ” or “ reasonable cost ”: Establish federal guidelines for state allowable cost definitions .
• Medicaid rate adequacy requirement : Medicaid rates are brought up to equal the cost of care and subsequently updated regularly to keep pace with increases in costs of care .
• State nursing facility Value-Based Purchasing ( VBP ) committee and required design report : The state will be required to form and maintain a state , health plan , and nursing facility VBP committee with specific guidelines and deadlines to submit reports . This offers the potential for additional resources .
References :
Centers for Medicare & Medicaid Services ( CMS ). National health expenditures data . Nov . 26 , 2019 . https :// www . cms . gov / files / zip / national-health-expenditures-type-service-and-source-fundscy-1960-2018 . zip .
Centers for Medicare & Medicaid Services ( CMS ). 2020 . Design for Nursing Home Compare Five-Star Quality Rating System : Technical Users Guide . Available at : https :// www . cms . gov / medicare / provider-enrollment-and-certification / certificationandcomplianc / downloads / usersguide . pdf
Centers for Medicare & Medicaid Services ( CMS ). COVID-19 Survey Activities , CARES Act Funding , Enhanced Enforcement for Infection Control Deficiencies , and Quality Improvement Activities in Nursing Homes . QSO-20-31-ALL . June 1 , 2020 .
Centers for Medicare & Medicaid Services ( CMS ). Enforcement Cases Held During the Prioritization Period and Revised Survey Prioritization ,” QSO-20-35-ALL . Aug . 17 , 2020 .
Coronavirus Commission on Safety and Quality in Nursing Homes : Final Report . September 2020 . Accessible at : cms . gov / files / document / covid-final-nh-commission-report . pdf
Government Accountability Office ( GAO ). COVID-19 in Nursing Homes : COVID 19 : Most Homes Had Multiple Outbreaks and Weeks of Sustained Transmission from May 2020 through January 2021 . GAO-21-367 . May 2021 .
Government Accountability Office ( GAO ). Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic . GAO-20-576R . May 20 , 2020 .
Government Accountability Office ( GAO ). COVID 19 in Nursing Homes : HHS Has Taken Steps in Response to Pandemic , but Several GAO Recommendations Have Not Been Implemented . GAO-21-402T . March 17 , 2021 ( b ).
Fulmer TT , Koller CF , and Rowe JW . Reimagining Nursing Homes in the Wake of COVID-19 . NAM Perspectives . Commentary , National Academy of Medicine , Washington , D . C . Sept . 21 , 2020 .
Grabowski DC and Mor V . Commentary : Nursing Home Care in Crisis in the Wake of COVID-19 . JAMA . 2020 ; 324 ( 1 ): 23-24 . May 22 , 2020 . doi : 10.1001 / jama . 2020.8524
Grabowski DC . 2019 Senate finance committee hearing : not forgotten : protecting Americans from abuse and neglect in nursing homes . Accessed January 19 , 2020 . https :// www . finance . senate . gov / imo / media / doc / Grabowski % 20Senate % 20Finance % 20testimony % 20 FINAL . pdf
Grabowski DC , Joynt Maddox KE . Postacute care preparedness for COVID-19 : thinking ahead . JAMA . Published online March 25 , 2020 . doi : 10.1001 / jama . 2020.4686
Hawes C . Assuring Nursing Home Quality : The History and Impact of Federal Standards in OBRA-87 . New York , NY : The Commonwealth Fund ; 1996 .
Salcher-Konrad M , Jhass A , Naci H , Tan M , El-Tawil Y and Comas-Herrera A . COVID-19 related mortality and spread of disease in long-term care : a living systematic review of emerging evidence . medRxiv preprint Aug . 1 , 2020 . doi :
https :// doi . org / 10.1101 / 2020.06.09.20125237
Telford CT , Bystrom C , Fox T , Wiggins-Benn S , McCloud M , Holland DP and Shah S . Assessment of Infection Prevention and Control Protocols , Procedures , and Implementation in Response to the COVID -19 Pandemic in Twenty-three Long-term Care Facilities in Fulton County , Georgia . medRxiv preprint , Aug . 15 , 2020 . doi : https :// doi . org / 10.1101 / 2020.08.13.20174466
Thomas KS , Zhang W , Dosa DM , et al . Estimation of Excess Mortality Rates Among U . S . Assisted Living Residents During the COVID-19 Pandemic . JAMA Netw Open . 2021 ; 4 ( 6 ): e2113411 . June 14 , 2021 . doi : 10.1001 / jamanetworkopen . 2021.13411
U . S . Senate . Nursing home care in the United States : Failure in public policy , Supporting Paper No . 1 . The Litany of Nursing Home Abuses and Examination of the Roots of the Controversy . Senate Special Committee on Aging , Subcommittee on Long-term Care . Washington , D . C .: U . S . Government Printing Office ; March 1 , 2019 .
U . S . Senate . Nursing home care in the United States : Failure in public policy . Senate Special Committee on Aging , Subcommittee on Long-term Care . Washington , D . C .: U . S . Government Printing Office ; 1974 .
Werner RM , Hoffman AK and Coe NB . Perspective : Long-Term Care Policy after Covid-19 — Solving the Nursing Home Crisis . N Engl J Med 2020 ; 383:903-905 . Sept . 3 , 2020 . DOI : 10.1056 / NEJMp2014811
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The Care For Our Seniors Act represents meaningful change that requires significant funding .
As AHCA / LeadingAge emphasize , “ Real , long-lasting transformation that will truly protect residents requires a considerable investment in the LTC profession .
www . healthcarehygienemagazine . com • aug 2021 • LTC Imperatives Special Issue
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