CMS provides reimbursement flexibility options for nursing homes
The flexibilities have been made available to "enhance payment" for nursing homes that have implemented COVID-19 infection-control practices.
The Centers for Medicare and Medicaid Services today released a Medicaid Informational Bulletin that identifies flexibility that can increase reimbursement for nursing homes during the COVID-19 public health emergency.
The flexibilities have been made available to "enhance payment" for nursing homes that have implemented infection-control practices, such as the creation of an isolation wing for COVID-19 patients.
WHAT'S THE IMPACT FOR STATES?
For state nursing homes, flexibilities include:
- Per diem dollar or percentage increases to existing base rates.
- Creating new payment methodologies for facilities acting as isolation centers.
- Modifying rate-setting strategies.
- Removing some payment penalties.
- Allowing for specialized payment adjustments.
- Creating new or modifying existing supplemental payments.
- Increasing payment rates for bed hold days.
"States can increase payments to recognize additional costs incurred in delivering Medicaid services, including additional labor costs and supply costs such as costs for personal protective equipment," the guidance said. "States can further target payment increases to nursing facilities that are treating residents diagnosed with COVID-19, or to nursing facilities in geographic areas that are experiencing an outbreak."
WHAT'S THE IMPACT FOR MANAGED CARE?
In states that use a managed care delivery system, direct specific payments made by managed care plans can be sent to providers through a state-directed payment, according to CMS.
The agency has set up an "expedited review and approval process" for the states that wish to implement direct payments.
THE LARGER TREND
CMS has reported more than 188,000 COVID-19 cases and more than 48,000 COVID-19 deaths in nursing homes to date.
This reimbursement guidance follows the announcement that nursing homes across the country face more than $15 million in fines from CMS for noncompliance with infection-control requirements and failure to report infection data during the pandemic.
In the CIB released today, CMS also included examples of states that have already used the flexibility.
In Iowa, the state created COVID-19 Relief Rate (CRR) payments of $300 per day to eligible nursing facilities for each resident. Ohio created a tiered payment system based on a resident's level of COVID-19 isolation. In it, facilities get $250 per quarantined patient day and up to $984 per patient day if mechanical ventilation is needed.
And in Michigan, facilities in "COVID-19 Regional Hubs" get an increased payment rate of $5,000 per bed in the first month and a supplemental payment of $200 per resident per day following the first month.
ON THE RECORD
"CMS encourages states to utilize the flexibilities available to support the nursing facilities' ability to safely care for all residents, including COVID-19 positive residents, during this public health emergency," the agency said. "CMS encourages states to do so through close alignment with applicable CDC guidance and in close coordination with the state agency responsible for survey and certification of nursing facilities."
Twitter: @HackettMallory
Email the writer: mhackett@himss.org
