President Biden to Unveil Nursing Home Initiative During State of the Union Address

The White House has announced that President Biden will unveil a series of initiatives aimed at improving nursing home quality in his State of the Union Address tonight, Tues., March 1^st, at 9 p.m. According to a Fact Sheet issued by the White House on Feb. 28^th, the proposals will "improve the safety and quality of nursing home care, hold nursing homes accountable for the care they provide, and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care." Goals of the reforms include ensuring that:

every nursing home provides a sufficient number of staff who are adequately trained to provide high-quality care;
poorly performing nursing homes are held accountable for improper and unsafe care and immediately improve their services or are cut off from taxpayer dollars; and
the public has better information about nursing home conditions so that they can find the best available options.

The White House statement focuses on the growing role of private equity firms in nursing home ownership – a model that, according to the White House, "places profits before people." It points to recent research that found worse outcomes and higher Medicare spending in private equity-owned homes.

The quality elements of the nursing home agenda will be implemented through four new initiatives to be launched by the Centers for Medicare and Medicaid Services (CMS):

Establish a Minimum Nursing Home Staffing Requirement: CMS intends to propose minimum standards for staffing adequacy that nursing homes must meet. It will conduct a research study to determine the level and type of staffing needed to ensure safe and quality care and will issue proposed rules within one year. CMS has already published new measures on Care Compare, which allows users to consider nursing home staff turnover, weekend staffing levels, and other important factors in their decision-making process. When the new minimum staffing requirement comes online, Care Compare will also prominently display whether a facility is meeting these minimum staffing requirements.
Reduce Resident Room Crowding: CMS will explore ways to accelerate phasing out rooms with three or more residents and to promote single-occupancy rooms.
Strengthen the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program: CMS intends to propose new payment changes based on staffing adequacy, the resident experience, as well as how well facilities retain staff.
Reinforce Safeguards Against Unnecessary Medications and Treatments: CMS will launch a new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications

To improve accountability and oversight, the President's agenda includes the following:

Urging Congress to provide almost $500 million to CMS to support health and safety inspections at nursing homes.
Overhauling the Special Focus Facility program to more quickly improve care for the affected residents and allow the program to scrutinize more facilities.
Expanding enforcement actions against poor-performing facilities based on desk reviews of data submissions, which will be performed in addition to on-site inspections.
Urging Congress to raise the dollar limit on per-instance financial penalties levied on poor-performing facilities from $21,000 to $1,000,000.
Calling on Congress to give CMS new authority to require minimum corporate competency to participate in Medicare and Medicaid programs, enabling CMS to prohibit an individual or entity from obtaining a Medicare or Medicaid provider agreement for a nursing home (new or existing) based on the Medicare compliance history of their other owned or operated facilities (previous or existing).
Urging Congress to expand CMS enforcement authority at the ownership level, enabling CMS to impose enforcement actions on the owners and operators of facilities even after they close a facility, as well as on owners or operators that provide persistent substandard and noncompliant care in some facilities, while still owning others.
Strengthening the role of Quality Improvement Organizations by exploring pathways to expand on-demand trainings and information sharing around best practices, as well as individualized, evidence-based assistance related to issues exacerbated by the pandemic.

To increase transparency in nursing home ownership, CMS will:

Create a new database that will track and identify owners and operators across states to highlight previous problems with promoting resident health and safety;
Ensure that Care Compare ratings more closely reflect data that is verifiable, rather than self-reported, and will hold nursing homes accountable for providing inaccurate information.

The agenda calls for creating pathways to good-paying jobs with an opportunity to join a union and includes the following workforce elements:

Reducing financial barriers to nurse aide training by ensuring that trainees are notified of their entitlement to reimbursement upon employment;
Supporting a template to encourage and enable states to tie Medicaid payments to clinical staff wages and benefits;
Launching the National Nursing Career Pathways Campaign.

To support pandemic and emergency preparedness, CMS will:

Continue to supply COVID-19 testing supplies to nursing homes;
Promote access to COVID-19 vaccination clinics and incentivize vaccinations through provider quality payment programs;
Clarify and increase the standards for nursing homes on the level of staffing facilities need for on-site infection prevention employees;
Consider changes to emergency preparedness requirements and work to bolster the resiliency of the health care sector;
Integrate new lessons on standards of care into nursing home requirements around fire safety, infection control, and other areas, using an equity lens.

Katie Smith Sloan, president and CEO of LeadingAge National, has released a response to the proposals, noting that: "Our system of enforcement shouldn’t be based on punishment over improvement; the system must be transformed." Katie's entire statement is available here.

LeadingAge NY will provide updates as more information arises.

Contact: Amy Nelson, anelson@leadingageny.org, 518-867-8383 ext. 146