Parkinson Warns of State Reopening Plans’ Impact on Nursing Homes, Potential Medicare Relief Clawbacks

Citing current patterns of COVID-19 infection rates at nursing homes, the leader of the nation’s largest post-acute and long-term care association on Wednesday warned against states opening their economies too early — a move that he said could only worsen the crisis.

“We are very concerned about states opening up too early for this simple reason: When you look at the facilities that have COVID-positive residents in them, the correlation isn’t any particular thing about the facility — its size, whether it’s a [for-]profit or not-for-profit. It’s not even particularly related to its survey history,” Mark Parkinson, president and CEO of the American Health Care Association (AHCA), said on a call with reporters. “Instead, there’s a direct correlation between the prevalence of COVID in the community and the prevalence of COVID in long-term care facilities.”

Multiple states in recent weeks have taken steps to restart their economies after implementing mandatory COVID-19 closures earlier this spring. Georgia, for instance, has permitted a wide swath of businesses — including barbershops, gyms, and movie theaters — to reopen over the past week, with Texas following suit on May 1.

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Even states with stricter shutdown timelines are slowly cracking open the blinds. Illinois, which remains under a mandatory stay-at-home order through the end of May, will allow non-essential businesses to operate under modified rules starting Friday.

But with thousands of deaths already logged in nursing homes, and asymptomatic transmission firmly established as a key vector of the virus in long-term care facilities, Parkinson urged state governors to consider their reopening plans carefully.

“If states open up too early, and we have a resurgence of COVID-positive cases in the general community, this virus is so infectious and so insidious, it will make its way into long-term care facilities,” he said.

Parkinson, himself the former governor of Kansas, said he understood the desire to kickstart local and state economies that have been ravaged by COVID-19 shutdowns. Still, leaders must keep the potential for devastation in long-term care settings in mind when weighing the costs and benefits.

“If we open up too soon, the results will not be good,” he said.

Parkinson’s comments came during a press call in which the AHCA CEO praised the Centers for Disease Control & Prevention (CDC) for finally bumping nursing homes up to the top priority level for tests this week; residents and staff who display symptoms will be moved to the front of the line, according to Parkinson.

He also welcomed reports that the Federal Emergency Management Agency (FEMA) will soon begin distributing PPE directly to the nation’s nursing homes, though he emphasized that details about the plan — reported by several outlets based on internal communications that included Vice President Mike Pence — remain scarce.

“We’ve been told that it will start around May 1, so hopefully this Friday or early next week,” Parkinson said. “But we don’t have any knowledge of what the amounts of the equipment will be, or if we’ll be notified in advance. We just have a general understanding of the program with no specifics.”

Access to testing and PPE remains the top priority for the trade group, which represents more than 14,000 nursing homes and assisted living facilities across the country.

“Obviously, this virus passes through coughing, and maybe even just through breathing, so the inability to access access to sufficient supply of masks has made it virtually impossible to stop the virus inside of buildings,” Parkinson said.

While states and the federal government have released a raft of new requirements mandating the use of PPE and the separation of COVID-positive residents into dedicated units, nursing facilities have remained at a lower priority level than hospitals, Parkinson noted — and without access to testing, operators aren’t able to effectively create positive and negative “cohorts” within their facilities.

Parkinson also called on the Department of Health and Human Services (HHS) to create a dedicated tranche of funding for long-term care operators, which thus far have been largely shut out of the $175 billion in emergency funding set aside for health care providers in federal stimulus bills.

HHS is in the process of wrapping up a $50 billion distribution to all providers based on their historical Medicare reimbursements, but as Parkinson and others have pointed out, the relief effort does not assist the thousands of nursing homes that rely primarily on Medicaid for their income.

Parkinson specifically requested $10 billion exclusively for nursing homes, adding that due to the staggered and rushed release of the Medicare rounds, some operators may have actually seen money taken out of their accounts when HHS released an additional $20 billion late last week.

“If a provider was heavily focused and dependent on Medicare funding, and therefore received a pretty good amount of money in the first round of payments two weeks ago, it’s entirely possible that they will have a negative payment in the payment that went out last Friday — and there are a number of skilled nursing providers that are in this situation,” Parkinson said. “We don’t know if HHS is actually going to claw back the money from the first payment or not. I think they’re considering that and haven’t decided yet.”

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