On September 3, 2020, the Department of Health and Human Services (“HHS”) announced the details of its $2 billion Provider Relief Fund (“PRF”) performance-based incentive payment distribution to nursing homes. “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. Last week, HHS delivered $2.5 billion to nursing homes to help with upfront COVID-19-related expenses for testing, staffing and personal protective equipment needs.

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.

Seven Keys

Keys to these incentive distributions.

  1. In order to qualify for payments under the incentive program, a nursing home must have an active state certification as a nursing home or skilled nursing facility and receive reimbursement from the Centers for Medicare & Medicaid Services.
  2. Nursing homes must also report to at least one of three data sources that will be used to establish eligibility and collect necessary provider data to inform payment:
    1. Certification and Survey Provider Enhanced Reports (“CASPER”);
    2. Nursing Home Compare (“NHC”); and
    3. Provider of Services (“POS”).
  3. There will be four one-month measuring periods; September, October, November and December of 2020 with $500 million available to nursing homes in each period. Each month is a new counting period and there is a separate payment each month.
  4. Nursing homes will be assessed based on a full month’s worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the prior month’s performance period.
  5. HHS will measure nursing homes against a baseline level of infection in the community where a nursing home is located.
    1. Centers for Disease Control and Prevention’s Community Profile Reports include county-level information on total confirmed and/or suspected COVID-19 infections, as well as information on COVID-19 test positivity.
  6. Nursing homes will have their performance measured on two outcomes:
    1. Ability to keep new COVID-19 infection rates low among residents; and
    2. Ability to keep COVID-19 mortality low among residents.

HHS will measure facility COVID-19 infection and mortality rates with data from the National Healthcare Safety Network (“NHSN”) LTCF COVID-19 module. We believe that nursing homes whose average new case count of COVID-19 is at or below other buildings in the same county will receive a payment.

  1. These incentive payments will be subject to the same HHS “Terms and Conditions” applicable to the initial nursing home infection control payments announced last week.

Four Actions to Take Now

  1. Assess if your nursing home wants to accept any of this incentive-based distribution.
  2. Establish practices and procedures regarding the timely and accurate submission of data to the NHSN.
  3. Review the HHS Terms and Conditions regarding the nursing home infection control distribution.
  4. Review and create procedures for tracking the use of the funds and that funds were not used for prohibited purposes.