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.
Keys to these incentive distributions.
- 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.
- 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:
- Certification and Survey Provider Enhanced Reports (“CASPER”);
- Nursing Home Compare (“NHC”); and
- Provider of Services (“POS”).
- 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.
- 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.
- HHS will measure nursing homes against a baseline level of infection in the community where a nursing home is located.
- 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.
- Nursing homes will have their performance measured on two outcomes:
- Ability to keep new COVID-19 infection rates low among residents; and
- 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.
- 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
- Assess if your nursing home wants to accept any of this incentive-based distribution.
- Establish practices and procedures regarding the timely and accurate submission of data to the NHSN.
- Review the HHS Terms and Conditions regarding the nursing home infection control distribution.
- Review and create procedures for tracking the use of the funds and that funds were not used for prohibited purposes.