Officials Offer Financial Incentives for COVID-Focused SNFs Ahead of Peak Cases: ‘It’s a Race at This Point’

Nursing homes in Connecticut will get a 10%, “across-the-board increase” in their Medicaid reimbursements — with operators that volunteer to turn their facilities into dedicated COVID-19 treatment facilities eligible for even greater financial benefits — as the state scrambles to respond to the growing crisis.

The office of Gov. Ned Lamont made the announcement on April 3, but the move came shortly after a flurry of changes to the way state officials viewed the role of skilled nursing facilities in the COVID-19 crisis.

The changing plans highlight the challenges states face in balancing the needs of COVID-19 patients with the vulnerability of residents in the SNF and post-acute settings.

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The 10% increase in Medicaid reimbursements to nursing homes starts from April 1 through June 30; an initial payment of $11.6 million is scheduled to go to nursing homes in the state on April 7, and the projected three-month increase is expected to come in at $35.3 million.

The additional reimbursement is to be used for staff wages, including overtime, retention bonuses and shift incentive payments; costs related to visitor screening, personal protective equipment (PPE), and cleaning and housekeeping supplies; and other costs related to COVID-19, according to a letter sent to nursing home providers on April 3 from the state Department of Social Services (DSS).

In addition, long-term care facilities that opt to be designated as COVID-19 facilities that specialize in the care of such patients will be eligible for $600 per-day payments for each person admitted — more than double the average daily Medicaid payment rate, according to the press release from Lamont’s office.

Connecticut is also offering to make that same payment to currently closed facilities designated by the state Department of Public Health (DPH) as appropriate for reopening to serve COVID-19 patients who need nursing home care.

The announcement comes after conflicting reports about whether or not the state would be designating specific SNFs as COVID-19 facilities.

There were initial reports in the Connecticut Mirror and the Hartford Courant of specific facilities flagged for COVID-19 patients who had been stabilized in the hospital or tested positive for the illness in another SNF or assisted living facility. In fact, a press release issued from the governor’s office on April 1 named several specific facilities and options for a “medical surge plan.”

On April 2, Skilled Nursing News received a copy of that release, which detailed several different components that would go into the surge plan, designed to ease pain on a health care system set “to be stretched to extremes.” Nursing homes were described as “an essential component” of the plan, which would have included separating COVID-19 patients from other residents, dedicating specific units for COVID-19 cases, converting existing SNFS to COVID-only ones, and establishing new sites for care.

However, shortly after it was posted, the release was taken down from on Gov. Lamont’s website.

According to Paul Liistro, the managing parter at the Arbors of Hop Brook Limited Partnership, the Vernon Manor Health Care Center, and the Manchester Manor Health Care Center, that’s because the plan from Lamont’s office was “prematurely announced.”

The state’s major trade groups for senior living and care providers — LeadingAge Connecticut, which represents not-for-profit entities, and the Connecticut Association of Health Care Facilities (CAHF), the local chapter of the American Health Care Association (AHCA) — were communicating with the governor and the state for five weeks to get a sense of how to handle the growing COVID-19 crisis, Liistro told SNN.

The state and the associations had discussed several options, including the opening of closed SNFs and the designation of specific facilities as COVID-19 skilled nursing facilities. Nursing home leaders proposed several facilities where residents with COVID-19 could be placed to receive care and avoid spreading the disease. But Liistro emphasized that at the time Gov. Lamont’s so-called “medical surge plan” was announced, those proposals were just that.

“It wasn’t a plan,” he told SNN on April 6. “It was a conversation.”

Backlash from family members and providers alike caused the governor to take down the April 1 release, but Connecticut is still looking to bring in nursing homes that can be designated as COVID-19 facilities. In the April 3 letter to providers, the DSS noted that it and the DPH “are in discussion with a number of homes” that might be able to become COVID-19 facilities.

The April 3 letter also came one day after the Centers for Medicare & Medicaid Services (CMS) made the practice of establishing separate COVID and non-COVID nursing home units or buildings a national guideline.

“Long-term care facilities should separate patients and residents who have COVID-19 from patients and residents who do not, or have an unknown status,” CMS wrote. “To this end, long-term care facilities should work with state and local community leaders to identify and designate facilities dedicated to patients and residents with known COVID-19-positive and those with suspected COVID-19, ensuring they are separate from patients and residents who are COVID-19-negative.”

Massachusetts had announced an initiative to set up dedicated SNFs for COVID-19 patients earlier this month, with Beaumont Rehabilitation and Skilled Nursing Center in Worcester, Mass., operated by Salmon Health and Retirement, slated to be the first such facility.

But though residents started to transfer to other locations, the move had to be halted because at least one resident tested positive for COVID-19, radio station WBUR reported. Just days later, plans to convert another SNF to a COVID-19 facility, AdviniaCare in Wilmington, Mass., had to stop because of 98 residents set to be moved, 51 tested positive while asymptomatic, the radio station reported.

The first such COVID-specific building in Connecticut, Westfield, is scheduled to open this week in Meriden, Conn., operated by Apple Healthcare of Avon, Conn., Liistro told SNN. That operator had some advantages: Apple owned the building and though it had recently closed, the operator still retained the license. Management was able to find the staff as well, Liistro added.

The goal is to free up hospital beds in expectation of cases in Connecticut peaking during the last few days of April and the first week of May, according to an article in NBC CT cited by Listro. The shortage of hospital beds could run into the thousands; the need is for about 1,200 to 1,500 hospital beds, and some of the current models project the state — which has about 9,000 hospital beds — running short by about 2,500 beds, Liistro told SNN.

“If two things happen — there are more dedicated facilities and we can flatten the curve — we may be able to manage this,” he said. “But it’s a race at this point.”

As of April 6, 86 of 213 nursing facilities in the state of Connecticut have at least one COVID-19 patient, Liistro told SNN. There may be more than one case in some of those buildings, he added. That adds to the challenge; SNFs that already have COVID-19 patients may not want to bring in more patients, whether for fear of infecting healthy patients or causing the infection to spread even more.

Liistro has first-hand experience of that calculus: A staff member at one of his buildings tested positive, and potentially infected several patients. It cannot accept any new patients as result.

And while the 10% Medicaid increase is welcome news to SNF operators, Liistro noted that it ends up translating to an increase of approximately $2 an hour for all departments at a given 120-bed SNF. That doesn’t come close to covering the costs of staffing the COVID-19 crisis, especially if facilities have to dedicate staff specifically to COVID-19 patients.

But Liistro is optimistic about the state’s progress overall. The increase is still appreciated, he noted, and the state has been responsive to the concerns raised by operators when it comes to both the plan for coping with the medical surge and the concerns about funding, he noted.

“We’re moving in a positive direction, and the governor and DSS are being responsive to the need,” Liistro said.

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