LeadingAge NY Seeks Changes in Nursing Home Staffing State Plan Amendment
In a letter to Centers for Medicare and Medicaid Services (CMS) Deputy Director Daniel Tsai, LeadingAge NY called for changes in the State's proposed methodology for distributing $187 million in funds to support compliance with nursing home minimum staffing requirements. The letter raised significant concerns with the State's proposed Medicaid State Plan Amendment (SPA), noting that it would violate the authorizing legislation and create perverse incentives by rewarding facilities that fail to meet minimum direct care spending requirements and excluding facilities that meet staffing requirements. In essence, the letter pointed out, the SPA actually discourages investment in staffing and rewards facilities that divert funds from resident care.
LeadingAge NY called for changes in the SPA to align with the authorizing legislation and legislative intent, including:
- Requiring compliance with the State’s minimum direct care spending requirements as a prerequisite for funds, as required in the appropriation legislation supporting the SPA;
- Authorizing supplemental payments to facilities that are in compliance with the State’s minimum staffing requirements, as well as to those that are not;
- Allowing pediatric, HIV/AIDS, and other specialty facilities to qualify;
- Applying the amended definitions of revenue set forth in minimum direct care spending legislation enacted in April 2022.
As previously reported, the proposed SPA seeks federal approval of supplemental payments to nursing homes in the amount of $187 million annually for each of three years, beginning in 2022. Contrary to the requirements of the appropriation legislation authorizing the funding, the SPA would allow supplemental payments to nursing homes that fail to meet the minimum direct care spending requirements (i.e., 70/40), although payments would be reduced for facilities that fail to meet the 40 percent requirement for resident-facing staff. The SPA further ignores the amendments to the minimum direct care spending requirements enacted as part of the 2022-23 State Budget. While authorizing payments to facilities that fail to meet minimum direct care spending requirements, the SPA would exclude from funding facilities that complied with staffing requirements in the final quarter of the year two years prior to the payment year (i.e., Q4 of 2020 for 2022 payments), even if those facilities failed to meet staffing requirements in subsequent quarters. The proposed SPA also excludes pediatric facilities and specialty facilities from funding, without statutory authority.
LeadingAge NY's letter pointed out the financial challenges facing nursing homes that strive to comply with minimum staffing requirements, given inadequate Medicaid rates. It warned of the possibility of additional closures and sales of high-quality providers and more limited choices for consumers if the inequities created by the proposed SPA are not addressed. LeadingAge NY will keep members apprised of developments in the distribution of funds as they arise.
Contact: Karen Lipson, klipson@leadingageny.org, and Darius Kirstein, dkirstein@leadingageny.org