As the nursing home industry passes the anniversary of sweeping reform initiatives by the Biden Administration, the proposed Centers for Medicare & Medicaid Services (CMS) budget for 2024 includes new dollars to strengthen federal oversight of the industry.
Specifically, the proposal seeks to reserve about $566 million for CMS Survey and Certification Program funding, a 40% increase above enacted funding for nursing homes and other facilities’ health and safety inspection surveys.
Oversight ability is a “key piece of our concerns around nursing homes,” CMS Administrator Chiquita Brooks-LaSure said in response to a question from Skilled Nursing News during a press briefing on the wider Department of Health and Human Services (HHS) 2024 proposed budget. HHS plans were released on Thursday, as part of the White House’s overall budget proposal.
Multiple enforcement provisions are baked into the proposed budget to protect seniors: identifying and penalizing nursing homes that commit fraud, endanger patient safety, or prescribe unnecessary drugs among them.
The Biden Administration’s budget proposal lays out the executive branch’s priorities and can influence the final federal budget to be established by Congress.
Coupled with oversight, Brooks-LaSure briefly touched on the nursing home staffing standards due to be released this spring.
When asked about funding for the staffing mandate, Brooks-LaSure simply said that skilled nursing funding is taken care of through Medicare and Medicaid final payment rules released over the course of the year.
The Medicare Final Rule is usually issued in July of each year – for 2023, SNFs saw a 2.7% increase in payments, reflecting a $1.7 billion increase resulting from a 5.1% bump to SNF payment rates. Operators also got a reprieve from adjustments related to the Patient-Driven Payment Model (PDPM), as CMS last year indicated a two-year phase in of adjustments.
There is $150 billion allocated in the proposed 2024 HHS budget toward home and community-based services (HCBS) caregivers, Brooks-LaSure said, to be spread out over 10 years. The budget also includes $2.7 billion for HRSA workforce programs, including $947 million to expand the workforce capacity across the country.
Associations like LeadingAge, which represents nonprofits in the nursing home space, appreciate the support to HCBS but remind HHS to consider all parts of the care continuum.
“The experience of our nonprofit, mission driven members, who serve older adults and families in a range of care settings and communities, bears out the truth: demand for services in all communities and care settings is growing,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “We share President Biden’s goal of ensuring quality care wherever older adults call home. Funding is needed across the continuum. We hope we will find that addressed as more details emerge.”
The discretionary budget also includes $28 million for a new program to address growing concerns surrounding the health care workforce shortage, and $25 million to shift toward “workplace wellness” in hospitals, rural health clinics, community health centers and medical professional associations.
Another $106 million is also earmarked for supporting public health training and fellowship programs to address future public health threats.
It’s unclear if any of these allotments would go toward the nursing home industry.
“We are very committed to improving long-term care, whether it be in nursing homes, in the community, and assisted living, and as a priority across the administration,” said Brooks-LaSure.
The proposed HHS budget includes $144.3 billion in discretionary funding and $1.7 trillion in mandatory funding for 2024, according to a statement issued by HHS.
Efforts focus on growing the economy from the “bottom up and middle out,” the statement read, lowering costs for families while protecting and strengthening Medicare.
For Medicare, HHS officials seek to extend program solvency at least another 25 years without cutting benefits, thanks to a proposed law package. Prescription drugs will be more affordable for seniors if the budget were to be enacted, as Medicare cost sharing on high value generic drugs is limited to $2.
About $7.1 billion may be put toward overall expansion of access to health care for low-income patients, rural and ethnic minorities, rural communities and people experiencing homelessness, according to the HHS budget statement.
This pot of money invests in what HHS calls community health centers, or community-based and patient-directed organizations that provide pharmacy, mental health, substance abuse disorders and oral health services.
