Lawmaker holds feet to fire: Q&A with Sen. Charles Grassley

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As one of the most influential politicians regarding long-term care funding and regulation, Sen. Charles "Chuck" Grassley (R-IA) has vowed to ensure extra funds actually go toward direct patient care costs. He says quality of care and the inability or unwillingness to hire enough staff are the biggest problems facing nursing home operators today.

Q You received some pretty strong commitments from nursing home associations, promising to spend future Medicare funding increases on direct care. How do you plan to monitor this commitment?

A I asked the Health and Human Services Inspector General to monitor this commitment and received an agreement from the administrator of the Centers for Medicare and Medicaid Services to keep better track of the use of this money and ensure that it's being spent as agreed.


Q What do you plan to do if the commitment is not adequately carried out? Who can help in this regard?

A I intend to make sure the commitment is carried out.  I intend to have the Health and Human Services Inspector General audit the providers' expenditures to ensure they follow the compact they entered into with me.

Tom Scully, the former administrator of the Centers for Medicare and Medicaid Services, proposed changes to providers' cost reports that will allow the Inspector General to monitor the use of the money so that it's spent on direct patient care. I'm also looking at legislation to codify this agreement.


Q Despite your protestations, it seems like the "feeding assistant" rule is here to stay. How will you track it?

A It's unlikely that I'll be able persuade the administration to withdraw this regulation, but I can monitor its impact, identify loopholes, and ensure that this legislation isn't used by unscrupulous providers to hire low-wage feeding assistants to replace certified nurses' aides.


Q What is your response to the Nov. 28 GAO report on Medicaid funding for nursing home care ("Medicaid Nursing Home Payments: States' Payment Rates Largely Unaffected by Recent Fiscal Pressures")?

A Two out of three nursing home residents receive at least part of their care from Medicaid funding, and $43 billion from Medicaid went to nursing home care last year. States have experienced three years of fiscal pressure. This report looks to answer the question of whether states' efforts to reduce Medicaid spending are hurting nursing home funding. The answer is no, and that's good news for nursing home residents.  

This report reveals that states are mak


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