Message From AHCA President Mark Parkinson
I usually send a mid-year update that summarizes the first half of the year and discusses what’s left. This year, our Medicare payment rule became so important, that I decided to wait until CMS released it. That happened on Friday, and the wait was worth it.
In a stunning turnaround, CMS reversed its proposed 0.7% CUT and has instead provided us a 2.7% INCREASE. Those new rates will go into effect on October 1, and last until September 30, 2023.
This much needed victory occurred for three reasons. First, we were right on the policy. While it is true that PDPM provided better than intended rates, this is not the time to fix that all at once. Too many SNFs are closing and many of those that aren’t are struggling. We convinced CMS that a phase-in of the PDPM adjustment was the right policy.
Second, our members demanded change. AHCA orchestrated a grassroots campaign, and you responded. CMS received 6,920 comments. These were not form letters. They were unique letters that explained the reality in our buildings right now. CMS has received more form letters on topics before, but I’m confident it has never received anything close to 6,920 unique comments on any topic. It mattered. In the rule itself, CMS noted “put the language in that discusses the input received.”
Finally, our political support mattered. At Congressional Briefing, we had 500 members assemble from across the country, and they convinced scores of members of Congress to contact the White House, HHS, and CMS on this topic. We supported bipartisan letters from Congress that garnered 22 senators and 18 representatives from the House asking the Administration to reverse the cut. And we had the support of Democratic leadership at every level who made calls on our behalf.
The result is needed and well deserved. It happened because thousands of administrators, DON’s, regional and corporate staff, and in some cases, CNAs got involved and made our case.
THERE IS MORE TO DO
The Medicare payment rule is just a part of what we need to do to recover from the COVID-19 nightmare. Unfortunately, long term care facilities continue to struggle with two realities: census is still low, and workers are still very difficult to find and retain. That data speaks for itself. On the census side, SNFs have only recovered about half of where we were pre-COVID. While the data on assisted living census is incomplete, it is clear that most of our AL providers also continue to struggle with occupancy.
Even more challenging is the workforce situation. While there is a workforce challenge everywhere, it is uniquely acute for us. SNFs and ALs across the country have lost workers. The reality is that many parts of the health care sector have already recovered from job losses early on in this pandemic.
WE NEED TO KEEP WINNING
We know you need more help until census recovers and the workforce issue is more manageable.
Our focus now will be in three areas. First, we need the federal Public Health Emergency declaration to continue. It is important for a variety of reasons. Many states have Medicaid add-ons that are tied to the federal declaration. Those additional payments only continue if the PHE continues. Across the country, we are able to skill residents without a three-day hospital stay during the PHE. Finally, additional Medicaid money flows to all states during the PHE and many, but not all states, are using those funds to help skilled nursing and assisted living providers.
HHS extended the PHE in mid-July for another 90 days. It now expires on October 13. We are lobbying right now to get it extended for an additional 90 days beyond October 13. The outlook right now is unclear. I view it as a 60/40 chance that HHS extends it again, and I’m confident that our lobbying efforts can improve those chances.
Our second area of focus is to help the state associations. The federal stimulus and recovery bills have sent hundreds of billions of dollars to state governments. The AHCA Board, led by Phil Fogg, has decided that we should do everything possible to help state associations access those funds. The Board set aside $5 million from our reserves to get involved in state efforts and that work has gone well. State after state has had success. The credit for this should not go to AHCA/NCAL. The success is due to outstanding state execs and their teams, and to the member leadership in those associations. But we are pleased to provide resources and consultants, and I believe the Board will continue to prioritize these efforts.
Finally, we are working on regulatory reform. This is both offense and defense. Let’s talk about offense first. We have heard loud and clear that the continued PPE and other related requirements for workers don’t make sense. We aren’t fighting the same virus now that we were fighting two years ago, and we have better tools than we had two years ago. Yet, the masking and other PPE requirements remain the same. Member after member has explained that it’s not fair to the staff and residents, and it’s making it hard to attract and keep staff.
We are trying to get this changed and need your help. Our Quality Cabinet—led by Mary Ousley, Gail Sheridan, and Debbie Meade, and staffed by Holly Harmon—has come up with a data driven/common sense plan that would relieve these burdens when COVID risks are low. We need the CDC and then CMS to understand how these requirements are not sustainable and make it hard on residents and staff. You can help us with this by writing the CDC and CMS on this topic. We encourage you to do so. Letters can be emailed to the CDC and/or CMS:
- CDC: [email protected]
- CMS: [email protected]
If you do send comments, please send a copy to AHCA/NCAL at [email protected].
We continue play offense for our assisted living members as well. We remain successful in keeping regulatory oversight of assisted living at the state level. NCAL has added a regulatory and policy director to engage with federal regulatory agencies (OSHA, CDC, CMS HCBS Division, etc.) and to support state affiliates in responding to state regulatory initiatives.
We are also playing defense. The Administration has made it clear that it intends to impose a minimum staffing requirement for nursing homes. We think this is a terrible idea for a variety of reasons but two stick out. There isn’t the money to cover the wages and benefits of the workers, and even if the money was there, the workers are not. The policy will not work.
We have a multi-level strategy to address this. This memo is not the time or place to walk through all the components of the plan. But we are going to need your help again. To either stop or shape the rule, CMS is going to have to hear from thousands of us. We will initiate a grassroots campaign over the next 60 days, and we will need you and your teams to get involved. Stay tuned for details.
The payment rule proves that when we unite, we can make a difference. We’re going to keep at it over and over and over until we get through this. And we will get through it.