White House Announces Nursing Home Care Reforms

In a fact sheet released on February 28, 2022, the White House announced measures intended to protect seniors by improving safety and quality of care across the nation's nursing homes. Specifically, the fact sheet announced that Centers for Medicare & Medicaid Services (“CMS”) will be launching four new initiatives to enhance quality of care

  1. Establish a Minimum Nursing Home Staffing Requirement.  CMS intends to propose minimum standards for staffing adequacy that nursing homes must meet. CMS will conduct a new 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. Nursing homes will be held accountable if they fail to meet this standard.
  2. Reduce Resident Room Crowding.  According to CMS, most residents prefer to have private rooms, but shared rooms with one or more other residents remain the default option. CMS believes that these multi-occupancy rooms increase residents' risk of contracting infectious diseases, including COVID-19. CMS will explore ways to accelerate phasing out rooms with three or more residents and to promote single-occupancy rooms.
  3. Strengthen the Skilled Nursing Facility (“SNF”) Value-Based Purchasing (“VBP”) Program.  The SNF-VBP program awards incentive funding to facilities based on quality performance. CMS has begun to measure and publish staff turnover and weekend staffing levels, metrics which closely align with the quality of care provided in a nursing home. CMS intends to propose new payment changes based on staffing adequacy and the resident experience, as well as how well facilities retain staff.
  4. Reinforce Safeguards Against Unnecessary Medications and Treatments.  CMS believes that inappropriate diagnoses and prescribing still occur at too many nursing homes. CMS will launch a new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications.

OIG Modifies Advisory Opinion Procedures

87 FR 1367 – The Office of Inspector General ("OIG"), Department of Health and Human Services ("HHS") issued a final rule amending the regulations governing the procedures for the submission of advisory opinion requests to, and the issuance of advisory opinions, by OIG. Specifically, the rule removes the procedural provision at 42 CFR 1008.15(c)(2), which precludes the acceptance of an advisory opinion request and/or issuance of an advisory opinion when the same or substantially the same course of action is under investigation or has been the subject of a proceeding involving HHS or another governmental agency. OIG believes removal of that provision will (a) offer OIG more flexibility in responding to requests for advisory opinions and (b) provide industry stakeholders with greater transparency regarding factors the Government may consider in evaluating compliance with certain federal fraud and abuse laws and distinguishing between similar arrangements.

Revisions to Rural Health Care Program

87 FR 14421 – This proposed rule seeks comment on several revisions to the Commission's Rural Health Care Program ("RHC Program") rules designed to ensure that rural healthcare providers receive funding necessary to access the broadband and telecommunications services necessary to provide vital healthcare services while limiting costly inefficiencies and the potential for waste, fraud, and abuse. The RHC Program provides vital support to assist rural health care providers with the costs of broadband and other communications services. Recent years have also seen an explosion in demand for telehealth services, a trend accelerated by the COVID-19 pandemic, that has increased the bandwidth needs of rural health care providers. Pursuant to this proposed rule, the Commission also seeks comment on proposed revisions to the RHC Program's funding determination mechanisms and administrative processes in an effort to improve the accuracy and fairness of RHC Program support and increase the efficiency of program administration.

Accountable Care Organization ("ACO") Realizing Equity, Access, and Community Health ("REACH") Model

CMS has redesigned the Global and Professional Direct Contracting ("GPDC") Model with the goal of advancing health equity. The Center for Medicare and Medicaid Innovation Center ("Innovation Center") is releasing a Request for Applications ("RFA") to solicit a cohort of participants for the Accountable Care Organization ("ACO") Realizing Equity, Access, and Community Health ("REACH") Model. The GPDC model will be renamed the ACO REACH model and will aim to accomplish the following goals:

  1. Advance Health Equity to Bring the Benefits of Accountable Care to Underserved Communities.  CMS will use an innovative payment approach to better support care delivery and coordination for patients in underserved communities and will require that all model participants develop and implement a robust health equity plan to identify underserved communities and implement initiatives to measurably reduce health disparities within their beneficiary populations.
  2. Promote Provider Leadership and Governance.  The ACO REACH Model includes policies to ensure doctors and other health care providers continue to play a primary role in accountable care. At least 75 percent control of each ACO's governing body must be held by participating providers or their designated representatives, compared to 25 percent in the GPDC Model. In addition, the ACO REACH Model goes beyond prior ACO initiatives by requiring at least two beneficiary advocates on the governing board (at least one Medicare beneficiary and at least one consumer advocate), both of whom must hold voting rights.
  3. Protect Beneficiaries and the Model with More Participant Vetting, Monitoring, and Transparency.  CMS will require additional information on applicants' ownership, leadership, and governing board to gain better visibility into experience in health care delivery, ownership and financial interests, and affiliations to ensure participants' interests align with CMS' vision. We will employ increased up-front screening of applicants, robust monitoring of participants, and greater transparency into the model's progress during implementation, even before final evaluation results, and will share more information on the participants and their work to improve care. The ACO REACH Model will also include stronger protections against inappropriate coding and risk score growth. 

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.