BACKGROUNDER: Biden-Harris administration announces new measures to improve the quality of nursing homes

For too long, nursing home residents have been victims of an industry with little accountability for the safety and protection of America’s elderly. COVID-19 has laid bare the challenges in American nursing homes, with more than 200,000 residents and staff dying from COVID-19. That’s why, in his State of the Union, President Biden launched an action plan to improve the safety and quality of care in nursing homes across the country. Today, the Biden-Harris administration announced new actions to increase accountability for bad actors in the retirement home industry, improve the quality of retirement homes, and make them safer. These efforts complement the administration’s investments in home and community services to prevent unnecessary admissions to nursing homes and to help nursing home residents return home when possible.

More aggressive enforcement for underperforming nursing homes
Today, the Centers for Medicare and Medicaid Services (CMS) announced new actions to significantly strengthen nursing home accountability under the Special Focus Facilities (SFF) program, an oversight program for less performance of the country. The SFF program already provides for more frequent inspections of these care homes, but additional measures are needed to ensure that these care homes are improved.

The SFF program reforms announced for the first time today:

  • Increase penalties for care homes in the program that do not improve: CMS will begin, effective immediately, using escalating penalties for violations, including considering facilities with dangerous violation citations in two successive inspections for termination of Medicare and/or Medicaid funding.
  • Raise safety standards for improvement: As part of today’s changes, CMS is increasing the requirements that nursing homes in the SFF program must meet to successfully complete and graduate from the program. Even after a facility has graduated from the program, CMS will now continue to closely monitor the facility for at least 3 years, which will help ensure that these nursing homes consistently maintain compliance with safety requirements.
  • Increase technical support: CMS is also increasing its engagement with these underperforming nursing homes, through direct and immediate outreach to CMS managers upon selection as SFF, to help them understand how to improve and access resources for support such as CMS quality improvement organizations.

More resources to support well-paying, unionized jobs in home care nursing
Sufficient and quality staffing is the measure most closely related to the quality of care residents receive. Creating well-paying, unionized jobs in the nursing home industry – and career paths to those jobs – promotes the “double dignity” of patients and workers. That’s why today, the Department of Health and Human Services (“HHS”) and the Department of Labor (“DOL”) are highlighting funds that are newly available to support pathways to nursing jobs from good quality, including care home workforce:

  • A wide variety of workforce stakeholders can apply for $80 million in grants available now: Until January 6, non-profit health care organizations, industry organizations or trade groups, labor unions, labor management organizations, education and training providers, health development entities workforce and Native American tribal governments can apply for the DOL’s Nursing Expansion Grant program, which will provide $80 million in grants to help address bottlenecks in workforce training. nursing workforce in the United States and to expand and diversify the pool of qualified nursing professionals. Specifically, these funds will help to: 1) increase the number of clinical and professional nursing instructors and educators, and 2) train frontline health professionals and paraprofessionals, including direct care workers , to progress along a career path and earn recognized post-secondary credentials, including Practical Nurses and Registered Nurses. This program will focus on training people from historically marginalized and underrepresented populations, which helps address the growing health equity gap in medically underserved communities.
  • HHS announcement $13 million in grants to expand nursing education and training: These funds made available through the Health Resources and Services Administration will help increase the number of nursing preceptors, i.e. experienced licensed clinicians who supervise nursing students during their clinical rotations. The expansion of preceptors will help support nursing schools’ goal of admitting more students by providing more opportunities for well-supported clinical rotations and, ultimately, career paths.
  • HHS and DOL will provide opportunity to apply for additional federal funds to support nursing workforce pipeline: HHS and DOL have identified hundreds of millions of dollars in funds that will come online over the next year to help improve nurse staffing and workforce sustainability. The Biden-Harris administration encourages eligible entities to weave together these programs to attract and retain high-quality workers to serve in healthcare professions such as health care aides, home health aides, and registered nurses:
    • By the end of this year, the Employment and Training Administration (ETA) of the DOL YouthBuild will make available approximately $90 million in grants for qualifying nonprofit organizations or qualifying consortia to provide education or job training under a federal program, to provide job training and educational opportunities to at-risk youth, with more than a third of recent recipients providing health-related training.
    • On an ongoing basis, ETAs National Grant Program for Displaced Workers makes tens of millions or more of grants available to eligible states, governor-designated outlying areas, and organizations eligible for funding through the Native American Programs to develop education in entry-level nursing professions such as Certified Nursing Assistant, Medical Assisting and Physical Therapy. These funds help expand training after major economic disruptions, such as factory closures, mass layoffs, or above-average demand for employment and training activities for dislocated members of the armed forces and their spouses. , with about three-quarters of beneficiaries linking participants. to health professions.
    • In the first half of 2023, ETAs WORC Initiative Grants will make available up to $35 million in grants to the state government, county government, eligible city or township government, special district government, regional organization, independent school district , public/state-controlled institution of higher education, private higher education institution, historically black colleges and universities, and Indian/Native American tribal governments. These grant funds enable impacted communities to develop local and regional workforce development solutions aligned with existing economic development strategies and community partnerships to promote new, sustainable employment opportunities and economic vitality in long-term, all to support displaced workers, new labor market entrants, and incumbent workers for good jobs in high-demand occupations, including behavioral health, dental health, and health informatics.

Building on other care home reform progress
Today’s efforts build on the many other steps the Biden-Harris administration has already taken to improve the quality and accountability of nursing homes since President Biden announced the Action Plan for Nursing Home Reform in the State of the Union:

  • Establish minimum staffing requirements: CMS has launched a public input process and research study that will inform future rule development on a minimum staffing requirement, and the proposed rule is on track to be published by spring 2023.
  • Fight against illegal debt collection: CMS is working with the Consumer Financial Protection Bureau to crack down on nursing homes that illegally hold families responsible for their loved ones’ debt.
  • Increase transparency and accountability: CMS has made more data available on owners of Medicare-certified nursing homes, helping families who shop for comparison understand if a nursing home is part of a bad chain. CMS also released public data — for the first time — on mergers, acquisitions, consolidations, and ownership changes for Medicare-enrolled nursing homes and hospitals.
  • Encourage quality performance through Medicare and Medicaid funding: CMS released a final rule updating Medicare’s policies and payment rates for fiscal year 2023, including a nearly $1 billion payment increase and updates to the patient quality reporting program. Skilled Nursing Facilities (“SNF”) and the SNF Value Based Purchasing Program. CMS also issued a bulletin encouraging states to use their Medicaid powers to improve health outcomes for nursing home residents and improve staff salaries, training and retention efforts, i.e. to link Medicaid payments to safety and quality of care measures.
  • Improve the ability of families to make comparisons: CMS has launched its enhanced Five-Star Nursing Home Quality Rating System, incorporating data on weekend nursing home staffing rates for nurses and information on annual nurse turnover. nurses and administrators. Updated star ratings increase transparency to make it easier for families to compare the reliable, quality care their loved ones deserve.
  • Prevent fraudsters from receiving Medicare funds: CMS released a proposed rule requiring nursing home owners to be fingerprinted for federal background checks to be eligible for Medicare funds, preventing Medicare abuse and fraud by nursing home owners .
  • Ensuring pandemic preparedness: CMS has updated its guidance to nursing home inspectors, including requiring infection control specialists to be on-site, not just off-site consultants as the previous administration allowed.


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