LeadingAge National Government News: November 13, 2024

Payroll-based journal (PBJ) data for Fiscal Year 2024 Quarter 4 (July – September) is due November 14. Nursing homes must submit all PBJ data for the quarter before this date for calculation in the Care Compare Five Star Quality Rating System. Data submitted after this date will not be accepted, regardless of the reason for late submission. Providers should run the following reports prior to November 14 to identify and correct any errors: 

1. 1700 Employee Report 

2. 1702D Individual Daily Staffing Report 

3. 1702S Staffing Summary Report 

4. MDS Census Report 

Providers who fail to submit PBJ data are automatically downgraded to a one-star in the Five Star Quality Rating System for staffing for that quarter and are assigned the lowest possible score for corresponding turnover measures. The lowest possible score remains in effect until the affected quarter times out. 

A November 7 report and fact sheet from the HHS Office of Inspector General (OIG) evaluated the effectiveness of the National Background Check Program, created under the Affordable Care Act, to enhance safety in long-term care settings. Between 2010 and 2024, 29 states participated in the program, utilizing over $100 million in federal and state funding to establish more robust systems for screening potential employees and disqualifying those with concerning criminal records, the report says. 

The National Background Check Program supported 27 states in establishing programs to develop efficient and cost-effective background check procedures for prospective long-term care employees. Two states, Maryland and Wisconsin, withdrew from the program early. Through the program, states successfully built systems to disqualify individuals with concerning criminal convictions from working in long-term care settings.  

The report highlights that automated background check systems and ongoing post-check monitoring were the most effective measures, significantly contributing to resident safety in long-term care. The States rarely reported any unintended consequences such as workforce reductions as a result of conducting background checks. The most common challenges states faced during the program were insufficient legislative authority at the state level and difficulties in coordinating efforts among various state departments. The OIG provided recommendations throughout the program that contributed to the positive outcomes in this final assessment.  

At this time, the OIG has no further recommendations for CMS. After the 2024 ending of the program, states continue to advance the initiatives established in the program by participating in the National Background Check Program Forum. With an increased focus on preventing abuse and neglect in nursing homes, CMS has updated survey guidance within the requirements of participation. The National Background Check Program enabled states to create systems for conducting background checks on prospective employees, helping to screen out individuals who might pose a risk of abuse or neglect. LeadingAge has continuously advocated for programs that prevent abuse, neglect and misappropriation of resident funds.  

On November 4, the journal Health Affairs published the study, “Loss of Public Health Emergency Funds Challenges the Financial Viability of Nursing Homes, Especially Not-For Proft Facilities.” The researchers analyzed financial and facility data from Medicare Cost Reports to assess how COVID-19 public health funding, including the Provider Relief Fund and the Paycheck Protection Program, allowed nursing homes to remain profitable through 2021. They examined financial performance metrics from 2018 to 2022 to track trends in the financial viability of for-profit and nonprofit nursing homes both leading up to and during the early pandemic years. The financial measures researchers calculated included net operating income, overall net income with public health emergency funds, and overall net income without these funds.  

To better understand the challenges nursing homes face, the researchers also evaluated occupancy rates, Medicaid payer mix, and nursing staff metrics. They noted concerns about related-party transactions, which they said could potentially bias financial performance results downward. Despite some limitations, including incomplete ownership information and variations in fiscal year reporting, the findings showed that nursing homes experienced declines in net operating income, which worsened during the pandemic.  

For-profit facilities generally reported smaller financial losses than nonprofits, the researchers found. Before COVID-19, for-profit nursing homes typically generated sufficient revenue to cover their operating costs, while nonprofits often relied on donations and other non-patient funding sources. Public health emergency funding helped stabilize nursing home operations through 2021. However, by 2022, as this funding was reduced, for-profits reported a modest net income of $1.68 per resident day, whereas nonprofits reported losses of $31.18 per resident day.  

The study also examined trends impacting nursing homes’ financial performance, such as occupancy rates and staffing levels. Nonprofit nursing homes consistently maintained higher nurse staffing levels than for-profits, although both saw increased reliance on agency staff from 2018 to 2022. Researchers emphasized that staffing remains a significant financial challenge that could affect future viability. While there may be opportunities to improve efficiency, establishing a sustainable long-term care financing system will be critical for nursing homes’ continued solvency.  

Long-term care financing has long been a policy goal for LeadingAge, and the findings underscore the current financial instability within nursing homes. Without policy intervention to address funding issues, access to high-quality nursing home care could be significantly reduced. The LeadingAge policy platform includes long-term services and supports financing reform including the goal to Promote equitable LTSS financing reform to ensure that people at all economic levels (including “middle income”) are able to access services when they need them.  LeadingAge will continue to advocate for financing reform as 2025 brings a new Administration and Congress. 

Guidance released by CMS on November 5 extends the deadline for nursing homes to complete the revalidation process to May 1, 2025. This change updates the original due dates outlined in the SNF Attachment on Form CMS-855A, which had an effective date of October 1, 2024. Importantly, this new timeline now applies uniformly across all states, whereas states affected by Hurricanes Helene and Milton had previously been granted extensions. The November 5 changes and updates also clarify the number of organizational charts that must be submitted and provide Frequently Asked Questions. 

LeadingAge advocated on behalf of its members regarding the revalidation process and timeline, voicing concerns to CMS about the limited time for compliance, the extensive data requirements, and the expanded list of disclosable parties. Through open dialogue with CMS, this advocacy has resulted in the revised deadline, providing nursing homes with additional time to meet the requirements.  

The November 5 guidance is as follows: Due Dates for All SNFs Regardless of when the SNF received its notice of revalidation letter from its MAC (i.e., October, November, or December), the revalidation application due date for ALL SNFs – irrespective of the state in which they are located — is May 1, 2025. This May 1, 2025, due date also applies to ALL SNFs that – as explained in Section (I)(B) above – had a pending initial, revalidation, reactivation, or CHOW application as of October 1, 2024, and were requested to submit the SNF Attachment. The Attachment will not be due until May 1, 2025. The previous restriction of the May 1, 2025, date to SNFs in Florida, Georgia, South Carolina, North Carolina, and Tennessee no longer applies.  

LeadingAge will continue to monitor the guidance and update members with any changes. In addition, LeadingAge will continue to engage with members regarding issues and concerns with the revalidation process in order to advocate for potential future changes in the process. If your organization is in the revalidation process currently, LeadingAge wants to hear from you. Please contact Janine Finck-Boyle. 

In the Calendar Year 2025 Home Health payment rule released on November 1, CMS finalized an aggregate .5% increase for home health providers in CY2025. While the final rule does not cut as deeply as was proposed, thanks to LeadingAge advocacy, the impact of this year’s rule, on top of two prior years’ cuts, will be harmful. In addition to payment updates, CMS is making changes to the collection of OASIS data for all patients as well as finalizing the addition of new OASIS items. Finally, CMS will be requiring a new condition of participation on January 1, 2025, requiring agencies to create an acceptance-to-service policy. Read more about the final rule here. 

LeadingAge is hearing of members and individuals in the community receiving COVID test kits from HHS and COVIDTests.gov that are past the expiration date marked on the box. Remember that many test kits have been granted extensions on expiration dates. You can check here to find out the updated expiration date on any test kits you receive. 

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