May 28, 2024 Washington, DC — In comments filed on the Centers for Medicare and Medicaid Services’ (CMS) FY25 Skilled Nursing Facilities (SNF) Prospective Payment System (PPS) proposed rule, LeadingAge, the association of nonprofit providers of aging services, including nursing homes, focused feedback on the agency’s 4.1% Medicare payment rate update and, among other items, the possible expansion of its authority to enforce civil money penalties (CMPs) on providers.
Regarding the proposed 4.1% payment rate update, while “welcome,” LeadingAge voiced concern that the increase still will not adequately capture nursing homes’ additional expenses resulting from the increased need for personal protective equipment (PPE) both to meet enhanced barrier precautions requirements and respond to needs of residents with COVID throughout FY2025, as well as higher recruitment and retention-related costs as providers prepare for implementation of staffing mandates in May 2026.
Also troubling, said LeadingAge, is the potential additional financial strain to providers should CMS expand its authority to enforce CMPs—without revising the survey process to allow for constructive feedback and educational support for providers. The proposal, which would allow for both per instance and per day CMPs to be enforced for noncompliance in the same survey and also to allow for multiple CMPs to be enforced in the same survey for the same noncompliance, threatens to force providers to make difficult choices. If, for instance, their CMPs increase, what trade offs must be made? Should spending on worker recruitment and retention or training staff on critical resident needs in areas such as behavioral health be reduced?
Many of our nonprofit, mission-driven nursing home provider members are asking the obvious: will the monies derived from the potential increase in monetary penalties be used to fund CMS’ $75 million staffing campaign—one created, the agency says, to assist nursing homes in meeting minimum staffing standards?
LeadingAge recommends a different approach. Rather than penalizing nursing homes through increased fines, CMS would do better by turning its attention to survey process reform—in particular, allowing for constructive feedback and educational support. A punitive approach focusing on fines alone will not improve quality of care in nursing homes.
CMS often contends that their role is one of enforcement and not quality improvement, but the two need not be mutually exclusive. Consistent application of standards and constructive feedback at the time deficient practice is identified will improve quality more effectively than slapping on a fine and walking away. What’s more, perhaps, by examining shortcomings of the current survey process and adopting policies that focus on collaborative learning, CMS will reduce the overall need for CMPs—which are a faulty method of exacting regulatory compliance.
