CMS encouraging states to use Medicaid payments to nursing homes to improve outcomes
The guidance grew out of reforms announced earlier this year meant to improve the safety and quality of nursing home care.
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In support of the administration's plan to improve the nation's nursing homes, the Centers for Medicare and Medicaid Services has issued an informational bulletin detailing actions that states can take using existing Medicaid authorities to drive better health outcomes for nursing home residents.
CMS expects these actions may also improve staff pay, training and retention efforts. The informational bulletin – issued by CMS' Centers for Medicaid and CHIP Services (CMCS) – provides examples of current state Medicaid initiatives that support the work.
The guidance grew out of a comprehensive set of reforms announced earlier this year by President Biden meant to improve the safety and quality of nursing home care, hold nursing homes accountable for their care, and make quality and facility ownership more transparent so potential residents can make informed decisions.
WHAT'S THE IMPACT?
CMS Administrator Chiquita Brooks-LaSure said Monday that states can immediately begin implementing a number of initiatives described in the guidance.
To ensure nursing homes are adequately resourced and staffed, CMS is urging states to tie Medicaid payments to quality measures that will improve the safety and quality of care.
"We know that low wages for staff can contribute to frequent turnover and dangerous staffing shortages at nursing homes, so we encourage states to work with these facilities to find solutions for training and improving staffing," said Brooks-LaSure.
CMS cited research showing a clear association between nurse-staffing ratios and nursing home quality of care, with evidence showing higher staff turnover was associated with poorer quality. Leveraging payment approaches to strengthen staffing further aligns with the new minimum staffing requirements for nursing homes.
Consistent with these efforts to establish minimum staffing requirements, CMS advises states to continue developing long-range solutions for training and improving staffing and workforce sustainability issues in nursing facilities. Individual states should look to state-specific data sources for measurable metrics by which improvements can be monitored and incentivized.
States are encouraged to work with facilities and CMS to determine if there are any costs, such as continuing education training for CNAs, that can be included in the payment rate for Medicaid services.
THE LARGER TREND
In the Medicaid program, states have broad flexibility to design their provider payment structures to incentivize providers for implementing or performing highly on various initiatives. Medicaid payments based on improvements to performance on quality measures have already been approved in numerous Medicaid State Plan Amendments (SPAs), such as in California and Illinois.
Similarly, to help reduce resident room crowding, states can implement Medicaid payment initiatives that adjust provider payment rates based on resident room occupancy, or set a higher payment rate for Medicaid residents in a single occupancy room, according to the agency. Whether integrated into the base rate or established as a separate value-based payment program, these efforts link payment to improved healthcare quality and shift from a focus on volume to value, said CMS.
CMS continues to encourage states to achieve a more equitable balance between the share of spending and the use of services and supports delivered in home and community-based settings, relative to institutional care like nursing homes.
The agency also said it's committed to strengthening the availability of Medicaid-covered home and community-based services (HCBS) as an alternative to institutional care. As a result of the American Rescue Plan, states are planning to invest $25 billion to expand, enhance and strengthen HCBS.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
