Illinois Medicaid Administrator Kelly Cunningham testifies during a hearing on a proposal to revise the way Illinois Medicaid nursing homes are reimbursed. (Photo credit: ilga.gov)
The nursing home industry continues to push for payment changes
BY PETER HANCOCK
Capitol News Illinois
SPRINGFIELD – Several Illinois lawmakers said this week they were determined to pass a bill this spring that would revise nursing home payments through the state Medicaid program to address critical staffing shortages, but the state’s largest nursing home industry group is always pushing still back against the proposed changes.
“In the interests of the weakest in our state, something has to happen this spring,” Anna Moeller, D-Elgin, said during a committee hearing on Tuesday. “And the point of these hearings is to bring this to light, to bring to light the reality of what people are going through.”
Illinois has many of the understaffed nursing homes in the country. According to a report by the State Department of Healthcare and Family Services, Illinois consistently ranks bottom of the state with 47 of the 100 most understaffed facilities in the country, as measured by the National Staff Time and Resource Intensity Verification, or STRIVE Project.
Mark Cooper, a nursing home resident who refused to identify the facility he lives in, told the committee about the conditions he faces on a daily basis.
“Lately, especially last year after this nursing home was apparently bought out by some other owners, there have been dirty conditions, food on the floor, feces in shower stalls, residents have been offered half-filled bowls of Froot Loops as a cold cereal option in the morning” , he said. “Lights called by residents that come on are not answered for half an hour or more.”
Kelly Cunningham, administrator of Illinois Medicaid, noted that the state has increased funding for nursing homes three times in recent years to increase staffing levels, but the shortage persists, particularly for certified nursing assistants or CNAs.
“With Medicaid being the largest single purchaser of CNA services, we are in a unique position to influence the purchase of these important services,” she said. âIt is clear that we need to tie any new funding for this industry directly to staff improvements and the quality of care to bring about the change we seek to give all care home residents the quality of life they deserve. “
Tuesday’s hearing was a joint meeting of four House committees dealing with health issues. They are considering a proposal from DHFS to revise nursing home remuneration by increasing funding and tying payments directly to headcount and performance metrics.
DHFS deputy director Andy Allison said the plan would see approximately $ 400 million increase in funding for Medicaid nursing homes tied to meeting certain staffing targets, increasing wages for CNAs, and achieving higher quality standards would.
That would be funded through an increase in nursing home assessment tax, which generates a pool of money that is used to claim additional federal Medicaid reimbursements.
âFor a facility that is 100 percent Medicaid, we would pay almost all of the increased headcount. It was designed that way, âhe said.
However, the plan is still met with strong opposition from the state’s largest nursing home industry group, the Health Care Council of Illinois.
HCCI Executive Director Matt Pickering told the committee that if the agency’s proposed new payment system were implemented, 130 care facilities in Illinois would experience an overall decline, of which up to 50 would be driven into bankruptcy. These 50 facilities, he said, serve more than 5,000 residents, mostly in rural and minority communities.
Pickering said the Illinois nursing home industry is already facing financial pressures for which he blamed much of the state’s privatized Medicaid system, in which for-profit insurance companies known as managed care organizations are responsible for reimbursing providers and managing them are responsible for the care of each patient.
“These challenges have merged into what we call the perfect storm for our industry,” he said. “Our financial burden is compounded by the managed care organizations that routinely refuse to reimburse providers treating low-income patients.”
However, Allison noted in his testimony that the 50 facilities HCCI identified prior to the COVID-19 pandemic were all high profits and “had exceptionally few staff, even compared to other for-profit establishments.”
“The most important question for these homes is whether they can accept staff,” he said. “So we looked at the cost of the replenishment, and even if, for example, we were probably overestimating the cost of $ 29 an hour for the additional hours of nursing that would be required in these homes to replenish them.” As a group, even with these costs under the proposed reforms, these houses would still make a profit overall. “
Meanwhile, MP Moeller said she argued that it was time the state stopped funding care facilities that provide substandard care.
“I don’t want to continue to subsidize these homes where … nursing home roommates have to look after other residents because there aren’t enough CNAs or nurses on the staff,” she said. âWe are paying hundreds of millions of dollars to subsidize these homes that provide this level of care. It’s obscene. So something has to change. “
Rep. Deb Conroy, D-Elmhurst noted that the committees had been working on reforming nursing home payments for several months and had an “agreed bill” sometime this fall that all parties could accept. She said it was time for the General Assembly to act.
“May I suggest that the agreed laws that we had a few months ago be tabled and those who have problems or want to see changes submit amendments,” she said. âThat way everyone can see clearly where the problems are. I think it’s important because this has become such a controversial issue. I think it is very important that all of our colleagues understand exactly what is going on. “
Legislators will return to Springfield on January 4th to schedule an abbreviated 2022 session. They hope to close their deal by April 8th.
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