The Department of Health and Human Services (“HHS”) recently released details about qualifying for its nursing home infection control distributions.
Previously, on September 3, 2020, HHS announced the details of its $2 billion Provider Relief Fund (“PRF”) performance-based incentive payment distribution to nursing homes (“NH Incentive Payments”). “Nursing homes” refers to skilled nursing facilities (often known as “SNFs”) for Medicare and nursing facilities (often known as “NFs”) for Medicaid.
This $2 billion distribution is part of HHS’s nursing home-focused targeted PRF distributions.
In a shift from prior PRF distributions, nursing homes will need to meet certain criteria to qualify for a portion of this $2 billion distribution.
How Do You Qualify for the NH Incentive Payments?
Nursing homes will not have to apply to receive a share of this incentive payment allocation. HHS will measure nursing home performance and distributing payments based on required nursing home data submissions.
To be eligible to receive an incentive payment, a nursing home must:
- Have an active certification as a nursing home or skilled nursing facility;
- Receive reimbursement from the Centers for Medicare & Medicaid Services (“CMS”);
- Report data to Certification and Survey Provider Enhanced Reports (CASPER), which will be used to establish eligibility and collect necessary provider data to inform payment;
- Demonstrate a rate of COVID-19 infections that is below the rate of infection in the county in which they are located; and
- Have a COVID-19 death rate that falls below a nationally established performance threshold for mortality among nursing home residents infected with COVID-19.
HHS will review nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS) to identify and remove facilities that have a terminated, expired or revoked certification or enrollment.
Permissible Uses for the NH Incentive Payments?
NH Incentive Payments may only be used for infection control expenses. HHS details that these include:
- Costs associated with administering COVID-19 testing for both staff and residents;
- Reporting COVID-19 test results to local, state or federal governments;
- Hiring staff to provide patient care or administrative support;
- Incurring expenses to improve infection control, including activities such as implementing infection control “mentorship” programs with subject matter experts or changes made to physical facilities; and
- Providing additional services to residents, such as technology that permits residents to connect with their families if the families are not able to visit in person.
When Will the Distribution of NH Incentive Payments Occur?
The NH Incentive Payments program is scheduled to be divided into four performance periods in 2020 (September, October, November, December), lasting a month each with $400 million available to nursing homes in each period. All nursing homes meeting the payment qualifications will be eligible for each of the four performance periods. Nursing homes will be assessed based on a full month’s worth of data submissions, which will then undergo additional HHS review and auditing before payments are issued the following month.
These four individual performance periods would be followed by an aggregate performance period that would measure performance across the entire four-month period from September to December. The aggregate performance period would have an available incentive pool of at least $400 million.
How Will Nursing Homes Be Assessed for Purposes of Issuing the NH Incentive Payments?
Nursing homes will have their performance measured on two outcomes:
- Nursing homes will be evaluated based on their overall COVID-19 infection rate among residents; and
- Nursing homes will be evaluated based on their performance for COVID-19 mortality among residents.
Performance measurements for each nursing home will be evaluated based on the population‑wide rate of COVID-19 infection in the geographic area in which a nursing home is located.
In order to measure nursing home COVID-19 infection and mortality rates, the incentive program will make use of data from the National Healthcare Safety Network (“NHSN”) Long‑term Care Facility Component COVID-19 Module. Within the NHSN module, HHS will incorporate weekly reported data on COVID-19 infections, COVID-19 mortality and the total count of occupied beds.
In addition, admissions of COVID-19-positive patients will be considered in order to focus accountability on infections acquired among existing residents. Using this weekly information, each nursing home will receive measurements of their COVID-19 infections per resident and COVID-19 deaths per resident in each performance month.
There will be an additional measurement of the baseline level of COVID-19 infection in the general community in which a nursing home is located. In order to measure the baseline infection rate, the program will make use of weekly updates of data included in CDC’s Community Profile Reports (“CPRs”). Data from the CPRs includes county-level information on total confirmed and/or suspected COVID-19 infections per capita, which will be used to measure the baseline infection rate for all eligible facilities located in that county.
Actions to Take Now
- Assess if your nursing home wants to accept any of this incentive-based distribution;
- Establish practices and procedures regarding the timely and accurate submission of data to the NHSN;
- Monitor timely reporting of data;
- Monitor accuracy of data that is reported; and
- Require the nursing home’s administrator to ensure staff complete the new CMS infection control online training.
If you have questions or would like assistance with this topic, please contact:
- Sean Fahey at (317) 977-1472 or sfahey@wp.hallrender.com;
- Todd Selby at (317) 977-1440 or tselby@wp.hallrender.com;
- Brian Jent at (317) 977-1402 or bjent@wp.hallrender.com; or
- Your regular Hall Render attorney.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
