Seeking Member Input on Nursing Home Five Star Quality Rating System
LeadingAge asked the Medicare Payment Advisory Commission (MedPAC) in a December 19 letter for a meeting to discuss the alternative approaches to calculating the Nursing Home Five Star Quality Rating System by changing how the various domains – staffing, health inspections, and quality measures — are weighted. We will be meeting with the MedPAC staff in early February to discuss our concerns with the current approaches they are considering, which include an option in which all domains are weighted equally, and a second option in which staffing is weighted more heavily than health inspections and quality measures. Learn more and read our letter to MedPAC here. LeadingAge is seeking member input on what changes, if any, should be made to Five Star. Please share your input with Jodi Eyigor.
LeadingAge to HHS: Revise COVID Guidelines for Healthcare Settings
LeadingAge sent a letter to Department of Health & Human Services (HHS) Secretary Robert F. Kennedy, Jr. on December 23 urging the Secretary to take immediate action to empower the Centers for Disease Control & Prevention (CDC) to update COVID guidelines for healthcare settings, including guidelines for patient/resident isolation and return-to-work guidelines for healthcare personnel. This letter is the latest in many previous actions taken by LeadingAge to highlight this issue, including both written advocacy and discussions with both CDC and the Centers for Medicare & Medicaid Services (CMS). LeadingAge pointed out that healthcare setting recommendations have not been updated since the end of the public health emergency and remain inconsistent with current general public health guidance. This discrepancy places unnecessary restrictions on older adults in nursing homes, solely because of their living situation. LeadingAge will continue to press for updates to these recommendations, which are enforced by CMS as accepted national standards.
All 50 States Awarded Rural Health Transformation Funding
The Centers for Medicare and Medicaid Services (CMS) announced December 29 that it will award all 50 states funding from the $50B Rural Health Transformation Program (RHTP). The funds are to be used to “expand access to care in rural communities, strengthen the rural workforce, modernize rural facilities and technology and support innovative models…”.
The CMS announcement lists the amounts each state will receive starting in early January 2026. First year awards range from $147M to $281M per state, with New Jersey receiving the least and Texas the most. State applications were assessed by federal and non-federal subject matter experts according to a “structured scoring framework” laid out in the Notice of Funding Opportunity (NOFO).
Most applications presented a 5-year budget request of $1B or $200M per year at CMS’s suggestion. Some states outlined detailed and varying requests over the 5 years. Georgia’s application, however, is an exception. The state asked for $1.4B over 5 years but will only receive $219M in the first year. If future annual awards are at this same level, their project will not be fully funded. In contrast, Kansas asked for $200M per year but was granted nearly $22M more than their request for year one. CMS notified states that they would hold pre-award budget review meetings with states in November and December. These discussions likely guided the final amounts awarded with some states indicating a need for more upfront funding to achieve their proposed plans and others recalibrating their proposals based upon feedback on their application. In the RHTP FAQs, CMS notes states are allowed to scale their initiatives up or down based upon the amount of funding they receive. However, states cannot add new initiatives or eliminate initiatives in their entirety based upon funding received.
Year one awards do not guarantee a state that same amount in subsequent years of the program. States must submit annual and quarterly progress reports to CMS and this progress or lack of progress can impact future funding. If a state fails to submit required reports, or follow the grant’s terms and conditions, make “satisfactory” progress on their identified metrics, or uses the funds for unapproved purposes, CMS can reduce, withhold or recoup awarded funds. States will be able to use the awarded amount from a given fiscal year through the end of the next fiscal year, except for funding received in FY2032, which can only be used through September 30, 2032.
