HHS Confirms Value-Based Structure for Coming $2B in Nursing Home Aid

The federal government on Thursday confirmed the value-based structure of the remaining $2 billion in federal aid to nursing homes, with facilities that beat baseline COVID-19 infection and mortality rates set to receive more relief.

The Department of Health and Human Services (HHS) will structure the remaining distribution as a kind of monthly contest, with $500 million up for grabs each month through the end of the year, starting in October.

All licensed nursing homes that reduce COVID-19 infections and deaths — compared to facilities in regions with similar overall virus transmission rates — stand to receive a portion of the money.


This most recent cash injection comes on top of about $2.5 billion already released to providers last week to cover testing costs as part of stricter Centers for Medicare & Medicaid Services (CMS) rules; the federal government now requires up to twice-weekly tests for nursing home staff, depending on the overall level of community spread.

The formal HHS announcement confirms the structure that American Health Care Association (AHCA) president and CEO Mark Parkinson described in detail last week during a webinar.

“I think it’s a really exciting program, and frankly, it’s a way to cover some of the testing costs that might not be covered by this tranche of funds that goes out today,” Parkinson said at the time, referring to the $2.5 billion that went to all operators regardless of performance.


HHS will develop the baseline metrics using county-level COVID-19 data from the Centers for Disease Control & Prevention (CDC), and compare those figures against infection and mortality rates collected in the CDC’s National Healthcare Safety Network (NHSN) database; nursing home operators have been required to submit that information to the CDC since May.

“Nursing homes will be assessed based on a full month’s worth of the aforementioned data submissions, which will then undergo additional HHS scrutiny and auditing before payments are issued the following month, after the prior month’s performance period,” the agency noted in its announcement.

Those baselines will vary to account for wide differences in overall case counts in specific regions. Research has indicated that community spread has a significant impact on outbreaks in nursing homes, and HHS will sort each facility into three comparison groups — low, medium, and high — based on those prevailing infection rates, Parkinson said last week.

The value-based incentive payments will be subject to the same terms and conditions as the earlier $2.5 billion distribution, HHS noted.

“The Trump administration has focused resources throughout our response on protecting the most vulnerable, including older Americans in nursing homes,” HHS secretary Alex Azar said in a statement. “By tying these new funds for nursing homes to outcomes, while providing the support they need to improve quality and infection control, we will help support quality care, slow the spread of the virus, and save lives.”

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