The administrator of the Centers for Medicare & Medicaid Services (CMS) placed nursing homes among her top areas of focus for the months to come, though she provided scant few other details during a wide-ranging press conference this week.
“I’m spending a lot of time on nursing homes,” Seema Verma said in a Wednesday afternoon “pen-and-pad” session with the media in Washington. “We laid out our five-part strategy in a blog that talked about quality, safety, enforcement, transparency, and reducing burden for providers. So a lot more work ahead on that.”
Though the questioning did not lead Verma back to a discussion of issues specific to nursing homes, the administrator touched on some state-level Medicaid issues, including proposals from states to switch their programs to block grants through a Section 1115 waiver.
“From having been a consultant working with states on Medicaid reforms, I can tell you that it’s always been difficult dealing with the agency,” Verma said. “The system that we have in place is very much a: ‘Mother, may I?’”
Moving forward, Verma said she wants to empower states to make more flexible choices with their Medicaid programs — the primary source of funding for nursing homes nationwide — with an eye toward potentially reining in spending.
“There should be some more accountability in the system. The Medicaid budget has grown and grown,” she said. “It is now the number-one or number-two budget item for most states, and that’s crowding out other priorities for the state — whether it’s education, infrastructure, schools, workforce, all kinds of different things.”
Verma also used the time to promote CMS’s recent work around Medicare Advantage, including a decision to allow plans to cover telehealth services with direct federal dollars. Previously, managed Medicare providers had to decide to pay for telehealth coverage out of their own internal budgets, making the service more of an optional add-on and not a direct benefit.
“I think plans are really excited about all the flexibility that we’ve been able to give them around providing supplemental benefits — also, some of the new flexibilities around telehealth have been very exciting for plans,” she said.
Still, as with the rest of the press conference, there was no direct line to nursing homes, with Verma instead emphasizing the importance of keeping Medicare Advantage enrollees in the community.
“We’re going to be as flexible as possible, because we think the plans need to look at all of the social determinants of health, and figure out: What is it that this patient is going to need to keep them healthy and independent?” she said.
Verma has been on something of a nursing-home push recently: The blog post she mentioned at the start of the press conference included an order for a “comprehensive review” of nursing home safety and quality standards. The April essay also touted stricter staffing standards, the effects of the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program for reducing hospital readmissions, and other enforcement efforts.
Under Verma, the agency has also overhauled the consumer-facing Nursing Home Compare website, breaking out separate five-star ratings for short- and long-term care services and tightening the requirements for receiving top marks.
“This is not business as usual — we are pushing beyond the status quo,” she wrote back in April. “We are focused on ensuring America’s nursing homes are keeping residents safe by rewarding quality and value, making outcomes transparent, and reducing unnecessary paperwork that detracts from patient care, and we will not hesitate to use every tool at our disposal to complete our mission.”