New York Offers $27M for Program That Shifts Skilled Nursing Residents to the Home

Officials in New York State have offered a $27 million grant to a non-profit that can help transition nursing home residents into home- and community-based settings.

The state’s Department of Health invited qualifying non-profits to submit their ideas for administering a Transition Center program, according to the official request for proposals (RFP).

Crain’s New York Business first wrote about the RFP on Monday.

The grant, which is part of the state’s Money Follows the Person (MFP) health care initiative, is expected to come in at $5.4 million per year over five years, for a total of $27 million — with a mixture of federal and state funds.

“The MFP program works to assure that residents of nursing homes throughout the state are provided with objective information to overcome challenges in accessing alternatives to unwanted institutional placement, and to assist in facilitating transition back to a community of choice,” the Department of Health noted in its RFP, released last week.

The state’s network of Transition Centers collaborate with nursing homes to identify long-term care residents who could potentially return to the community, with continued transition assistance for those who opt to leave the institutional setting.

The program itself is not new — but an RFP seeking another contract for ongoing work is, Nancy Leveille, the executive director of the Foundation for Quality Care of the New York State Health Facilities Association (NYSHFA), told Skilled Nursing News.

While the NYSHFA works with the groups that facilitate patient transitions to the community, SNFs in the state already discharge patients who are ready and wish to leave, regardless of the MFP.

“At the New York State Department of Health, there’s a big push to discharge residents to the community,” she said. “However, we’ve been doing that for years, because part of our whole process — based on regulations — is to get residents to the most practical level of care they can achieve. If they no longer need skilled nursing care, as soon as they’re ready, we discharge to the community.”

From 2008 to June 2018, a little over 4,000 individuals transitioned from institutions into the community setting through New York’s MFP program, according to Department of Health.

“That’s a number we look at — for the amount of money that’s being spent, is that worth the money?” Leveille told SNN.

In particular, industry leaders question why the state allocates funds for transition programs while neglecting Medicaid, the key funding source for nursing homes in New York and across the country. Like many other states across the country, the Empire State has a funding gap between reimbursements and the cost of caring for Medicaid residents, which Leveille said sits at $68 a day per Medicaid patient.

The RFP also comes on the heels of a study that raised questions about how well patients sent home from hospitals recover in that setting. The findings, published in JAMA Internal Medicine in March, found higher readmission rates for residents sent to a home health agency from the hospital than those discharged to SNFs.

And at the inaugural Skilled Nursing News Summit in Chicago last week, SNF leaders argued that amid the push to home and community services, SNFs could make a case that they already provide the most cost-effective care for their current patients.

“It goes back to the math, especially with this major push across the country with Medicaid managed care — the Medicaid managed care firms that own that risk, they’re going to look for the lowest-cost provider they can find,” Brian Cloch, the chairman of attunedCare, said at the summit. “And when they try to shift it to home, they’re going to realize that the people who are living at home are in and out of the hospital so much, it’s increasing their costs. So going to a SNF is going to be a far better deal.”

Leveille additionally argued that there’s no benefit for a nursing home to encourage long-term residents to overstay their need, as they draw the lowest reimbursement relative to other patients.

She emphasized that NYSHFA doesn’t have a problem with RFP or the program itself, and the SNFs in the state actively work with the groups that have worked to transition patients.

“But when we look at the overall picture of needs, and how the money is spent … we need some help,” she said. “And the residents — it’s not like we’re holding on to lower-level skilled people, unless there’s no place for them to go or if they choose to stay. If they want to stay there, it is their choice.”