CMS announces nursing home initiatives highlighted in the 2022 State of the Union address

President Biden delivered the State of the Union address on March 1, 2022. Included in the address were a set of reforms that will be developed and implemented by the Department of Health and Human Services (HHS) that “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.” 

The reforms include: 

• Every nursing home will be required to provide a sufficient number of staff who are adequately trained to provide high-quality care; 
  
• Poorly performing nursing homes will be held accountable for improper and unsafe care and immediately improve their services or face loss of taxpayer dollars; and 
  
• The public will be given better information about nursing home conditions so that they can find the best available options. 

 As a result, the Centers for Medicare & Medicaid Services (CMS) is launching four new initiatives. 

1. Establishing a minimum nursing home staffing requirement; nursing homes will be held accountable if they fail to meet this standard. 
2. Reducing resident room crowding by phasing out rooms with three or more residents and promoting single occupancy rooms. 
3. Proposing payment changes to strengthen the skilled nursing facility value-based purchasing (VBP) program with payment changes based on staffing adequacy, resident experience and staff retention. 
4. Launching an effort to safeguard against unnecessary medications and treatments and identifying problematic diagnoses related to antipsychotic medications.  

 These initiatives will include a robust compliance program that includes: 

• Adequate funding for health inspections with a request of $500 million to fund nursing home health and safety inspections. 
  
• Overhauling the Special Focus Facility (SFF) program to make its requirements tougher and more impactful. CMS will also make changes that allow the program to scrutinize more facilities, by moving facilities through the program more quickly. Facilities that fail to improve will face increasingly larger enforcement actions, including termination from participation in Medicare and Medicaid, when appropriate. 
  
• Expanding financial penalties and enforcement sanctions by making the per-day penalties the default penalty for non-compliance and requesting Congress to raise the dollar limit on per-instance financial penalties on poor performing facilities from $21,000 to $1,000,000. 
  
• Asking Congress to give CMS authority to require corporate competency to participate in the Medicare and Medicaid programs, prohibiting individuals from obtaining provider agreements for a nursing home based on their compliance history. 
  
•  Asking Congress to enable CMS to impose enforcement actions on owners and operators even after their nursing homes have closed.  
  
• CMS will provide technical assistance to nursing homes to help them improve as a core mission with on-demand training to share best practices.  

CMS also will require increased transparency related to facility ownership, including: 

• Making facility ownership and finances information easier to find on the Care Compare website. 
  
• Adding to the Care Compare information whether a facility is meeting the new minimum staffing requirements. 
  
• Taking action against facilities that submit inaccurate information to Care Compare. 
  
• Requiring HHS and other federal agencies to examine the role of private equity, real estate investment trusts (REITs), and other investment ownership in the nursing home sector and informing the public when corporate entities are not serving their residents’ best interests. 

Another group of initiatives includes creating pathways to healthcare jobs that include: 

• Increasing the affordability of nurse aide training programs through widely publicized free training opportunities. 
  
• Supporting states with workforce sustainability by encouraging them to correlate Medicaid payments to clinical wages and benefits. 
  
• Conducting a robust nationwide campaign to recruit, train, retain, and transition workers into long-term care careers, with pathways into health-care careers like registered and licensed nurses. 

Additional initiatives from the address related to emergency preparedness, including: 

• Continuation of COVID-19 testing in nursing homes. 
  
• Continuation of COVID-19 vaccinations and boosters in nursing homes. 
  
• Increase in the standards and requirements for nursing home infection preventionists. 
  
• Enhancement of requirements for emergency preparedness. 
  
• Integration of pandemic standards of care into nursing home requirements for fire safety, infection control and multiple other areas. 

More information regarding the reforms and initiatives included in the full White House Fact Sheet. 

For more information on this topic, or to learn how Baker Tilly’s team of healthcare specialists can help, contact our team.