$5K settlement for nursing home that declined to admit opioid dependent patient

Share this content:
NQF gives guidance for opioid use.
NQF gives guidance for opioid use.

A skilled nursing facility that denied admission to a patient receiving medically assisted treatment for an opioid addiction has settled federal discrimination charges.

The Justice Department announced the agreement, reached last week, in an email Monday. Charlwell Operating LLC, owner of the 124-bed Charlwell House in Norwood, MA, will pay a $5,000 civil penalty, agree not to discriminate against other patients being treated for opioid use dependency, and stop screening out such individuals.

The government's accusations date to 2017, the year after Charlwell adopted policies stating the facility would maintain use of physician prescribed treatments for OUD, including Suboxone and methadone.

But when a hospital requested a bed for a patient on Suboxone, the settlement says the nursing home denied admission “due to suboxone and state regulations.” The Justice Department later found that the facility had accepted no residents needing medically assisted treatment since creating its policy.

“In practice, Charlwell imposed eligibility requirements that screened out individuals with OUD,” in violation of the Americans with Disabilities Act, the government argued.

Whether skilled nursing facilities are required to accept patients on the highly regulated treatment drugs is an area of unsettled law. Federal law and regulations limit who can prescribe and oversee suboxone and similar drugs, meaning nursing homes would have to ensure they have the right people on staff for patients with those needs. (See this recent guest blog from a pair of long-term care pharmacists, “Unfortunately, turning away opioid addicts might be necessary.”)

As late as last month, the American Health Care Association had argued that the Centers for Medicare & Medicaid Services specifically prohibits nursing homes from accepting patients for whom they cannot provide appropriate care.

“The concern with many of our members is that it [medically-assisted addiction treatment] requires specialized training and staff, especially if it's someone with an active problem,” Senior Vice President David Gifford, M.D. told McKnight's then.

He compared selective admissions to accepting patients who use ventilators and need respiratory therapists and other supports. Facilities can deny those patients if they don't have services in place.

In a statement emailed to McKnight's Monday night, AHCA said the settlement appeared specific to one center.

"We are reviewing the settlement to better understand its implications for skilled nursing facilities," AHCA said.  

The settlement with Charlwell doesn't address the CMS defense. Instead, it says the facility has 30 days to develop a non-discriminatory policy that protects potential residents with OUD; train its admissions employee to let those patients in; and log prospective and admitted residents on medically assisted treatment.

In exchange, the Justice Department agreed to end its investigation without civil action.