State News for September 2016

DePasquale says too few SNFs are monitoring and reporting staffing levels, and the state isn't imposing enough fines.
DePasquale says too few SNFs are monitoring and reporting staffing levels, and the state isn't imposing enough fines.

Northeast

Audit slams state's minimum staffing requirements and level of SNF oversight

PENNSYLVANIA - State officials should crack down on minimum staffing requirements for nursing homes, according to a new report.

Skilled nursing facilities are required to provide a minimum of 2.7 hours of direct care to residents each day, but few facilities adequately monitor and document their staffing levels, state Auditor General Eugene DePasquale said in a report released in late July.

The state Department of Health issued staffing citations for facilities only 0.2% of the time it conducted surveys, the audit found.

“That is an unbelievably low number,” he said. “Clearly, prior to this audit, DOH was not getting to the root of the problem.”

DePasquale also said the DOH's documentation of nursing home complaints was insufficient, and criticized the low number of state sanctions and fines of facilities.

“DOH has considerable administrative discretion when pursuing sanctions, and we agree that not every instance of noncompliance may warrant a fine,” he said. “However, when a facility is not sanctioned but could have been, there needs to be an explanation.” 

Healthcare funding restored

MASSACHUSETTS — State healthcare workers had reason to rejoice in late July, when lawmakers overrode a veto by Gov. Charlie Baker (R) that would have halved a $35.5 million funding boost for the workforce.

Baker cut the funding in early July, as his administration was “grappling with a significant tax revenue shortfall,” the Boston Globe reported.

Tyrék Lee, leader of the 1199SEIU United Healthcare Workers East, applauded the lawmakers' move to restore the funds, which will be used to raise nursing home workers' salaries. 

“The Legislature took decisive action to protect funding that raises wages for thousands of Massachusetts nursing home workers,” Lee said in a statement. “Quality care is directly linked to quality jobs, and this funding is essential to ensuring quality long-term care for seniors, people with disabilities and their families.”

AG sued over facility sale

NEW YORK — The controversial pending sale of a Harlem nursing home led its owners to sue the state attorney general in late July.

The $32 million sale of The Greater Harlem Nursing Home was approved by New York Attorney General Eric Schneiderman in May. The approval has since been reversed after it was discovered that the buyer, The Allure Group, allegedly tried to conceal its identity during the transaction.

The Allure Group is currently under investigation by Schneiderman for buying the Rivington Street Nursing Home in New York, NY, and selling it for housing developments — making $72 million in profit in the process. 

The Greater Harlem Nursing Home's suit claims the AG had given no evidence that any “prosecutable” action had occurred, and therefore can't stop the sale.

“As our office has documented in great and troubling detail, Allure made clear and repeated promises to continue the operation of nursing homes for the benefit of a vulnerable population — promises that proved to be false,” AG spokesman Matt Mittenthal told the New York Post.

Southeast

Association under attack

ARKANSAS — A large Arkansas provider association found itself the subject of an ethics complaint in July over donations it made to a state ballot question committee.

The Arkansas Health Care Association gave $330,000 to the Health Care Access for Arkansans, a committee aiming to get a proposed constitutional amendment on the state's ballots in November that would limit attorneys to receiving one-third of the total damages in civil suits and place a $250,000 cap on noneconomic damages, such as pain and suffering.

Matt Campbell, attorney and blogger for the Blue Hog Report, filed a complaint with the Arkansas Ethics Commission. 

Campbell argues that AHCA counts as a ballot committee itself since it put at least 2% of its annual revenue toward a political action group. Ballot committees must disclose their financial records and donation sources.

“Contributions from the Arkansas Health Care Association made to the Health Care Access for Arkansans ballot initiative came from dues already collected from our members,” Rachel Davis, executive director for AHCA, told McKnight's. “The AHCA Board of Directors voted unanimously to use these existing funds to support the initiative.”

Penalty committee axed

NORTH CAROLINA — A House bill signed by Gov. Pat McCrory (R) in July eliminated the state's Penalty Review Committee, a group that has held public hearings and proposed fines against nursing homes in violation of state regulations since 1987.

Industry insiders said the committee had lagged on its work, and that penalty hearings for long-term care facilities could be better handled by the state Department of Health and Human Services, according to North Carolina Health News.

Penalties proposed by the committee were eventually reviewed by the health department, and often lowered. 

“Where at one time it had been a good committee, it had become a place for lawyers to come to take notes to sue,” Lou Wilson, a long-term care lobbyist, told North Carolina Health News

West

End-of-life orders embraced

CALIFORNIA — Nearly half of all nursing home residents in California completed a form expressing their end-of-life wishes in 2011.

That's according to researchers from the University of California-Los Angeles who analyzed data from the Long-Term Care Minimum Data Set to determine how many nursing home residents chose to fill out the voluntary Physician Orders for Life-Sustaining Treatment, or POLST, form.

The POLST form covers residents' end-of-life preferences, including resuscitation orders, aggressiveness of medical treatments and artificial nutrition. California currently is the only state that includes questions about the forms' completion on the MDS.

Researchers found completion of the POLST forms grew from 33% at the start of 2011 to 49% by the end of the year. Investigators noted wide variation in form completion among nursing facilities. About 20% reported completion of less than 10% of residents, while 40% reported high completion by more than 80% of their residents. 

Midwest

Managed Medicaid woes

IOWA — Iowa Medicaid providers have been hit with numerous issues related to the transition of the state's $5 billion Medicaid program to private insurers on April 1, according to a recent survey.

Healthcare providers submitted their concerns and challenges about the transition to state legislators via social media. Results of the survey were released in July. 

Providers report receiving late and inaccurate Medicare payments, as well as facing increased administrative costs and an overall reduction of services. Many nursing homes and rehabilitation providers have also seen “slow or inaccurate payments that have forced them to dip into savings,” according to the Cedar Rapids Gazette.

Ben Hammes, a spokesman for Gov. Terry Branstad (R), told the newspaper that the Democrat-conducted survey was “unverified” and “unscientific.” Hammes added that the survey represented just 1% of the state's 29,000 Medicaid providers. The state Senate Human Resources committee held a four-hour meeting on the topic in late July.