Even though the federal government has released the full details behind the most recent $5 billion tranche of aid for nursing homes, set to last through December, operators shouldn’t necessarily think that the support will end there.
Citing $50 billion still left in the Department of Health and Human Services’ (HHS) coronavirus relief coffers, American Health Care Association (AHCA) president and CEO Mark Parkinson expressed optimism that most funding will reach the nursing home sector.
“We think we have a shot at it,” Parkinson said during a virtual leadership talk hosted by the eCap conference and published last week. “A lot of folks have said SNFs aren’t going to be able to get any more because of what we’ve already received, but we don’t accept that.”
The $5 billion distribution — split between direct payments and a value-based competition that will last through the end of December — joins an earlier $4.9 billion chunk of CARES Act funding directed to long-term and post-acute operators.
Nursing home providers could also tap into separate Medicare- and Medicaid-specific distributions, and participate in a since-completed advance Medicare payment program.
But AHCA, which represents for-profit companies in the space, has been discussing a plan to further support hard-hit nursing facilities, according to Parkinson.
Under that proposal, facilities would be able to submit proof of lost expenses that earlier aid distributions did not cover, and receive the difference in targeted aid.
“We’re still early in those discussions, but don’t assume that this $5 billion is the end of it. I think we still have a real shot at some more revenue — and aid that would be smarter,” Parkinson said.
The trade-group leader expressed confidence that the federal government would at least delay, if not completely forgive, repayment of those advance Medicare payments.
At the end of March, the Centers for Medicare & Medicaid Services (CMS) allowed operators to receive up to three months of their future Medicare reimbursements in advance, with repayment required within 120 days of receiving the funds. CMS suspended the program in less than a month in the wake of direct CARES Act distributions to providers, but not before floating $100 billion to Medicare Part A and Part B operators, according to the government.
With the pandemic dragging on into the fall, however, the government may not necessarily be in a rush to recover the funds.
“All the policymakers understand we’re not in a position to pay the money back yet,” Parkinson said in the eCap discussion, adding that many Medicare Administrative Contractors (MACs) are simply ignoring the repayment requirements and paying claims as normal.
But HHS, CMS, and the Trump administration are limited in their ability to formally delay or forgive those advanced payments without Congressional action, Parkinson said. A repayment grace period is supported by both Democrats and Republicans, but in the absence of a follow-up stimulus package, the future of the advance Medicare payment remains up in the air.
“Unfortunately, with the stimulus bill not passing, we’re in limbo right now,” Parkinson said. “CMS and the White House do not want us to have to pay that money back right now.”
If a CARES Act sequel does indeed make it through a sharply divided Congress, it likely won’t happen until the end of this month, Parkinson said.
While a Democratic landslide in November could potentially give life to the idea of permanent repayment forgiveness, the AHCA CEO emphasized that repayment delays are the likelier outcome.
“I think we’re going to succeed, in one way or another, in getting those delayed,” Parkinson said. “My advice would be: Submit your claims, and I don’t think you’re going to have money withheld.”
The question of legal liability protections also looms large over potential future stimulus bills, with Democrats generally opposed to the concept — but Senate Majority Leader Mitch McConnell vowing not to pass any more support legislation without it.
Immunity has emerged as one of the most controversial issues in the wake of COVID-19; consumer advocates have argued that attempts to limit liability take away residents’ access to their only avenue of justice in cases of abuse and neglect, while the industry has emphatically stated that a wave of lawsuits over COVID-19 could prove financially ruinous and throw the future of the sector in doubt.
Parkinson said he believes McConnell will hold firm on the issue; the liability protections floated by Congressional Republicans would cover businesses across sectors, and Parkinson framed them as vital for restarting the economy as a whole.
Liability provisions were indeed included in an updated version of the Republicans’ stimulus package, introduced Tuesday.
But Parkinson also raised serious concerns about a future without the liability provisions.
“If we don’t get it … I don’t have a clear picture of where we’re headed,” he said. “It’ll be quite bad.”
That said, Parkinson painted the financial strain on the industry as a potential bulwark against attorneys who may look at the COVID-19 crisis in nursing homes as a chance for major class-action lawsuits.
“The plaintiffs’ lawyers are discovering that the sector is not well capitalized. I think they have thought that the whole class-action thing against nursing homes and COVID was going to be another round of asbestos or opioid litigation,” he said. “It’s not that, because we’re not capitalized well. A number of our big companies are struggling.”