A nurse with money in their pocket
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CHICAGO — The Centers for Medicare & Medicaid Services is considering requiring nursing homes to spend a minimum amount of federal Medicaid reimbursement dollars on direct care workers as the agency pushes ahead on its reform agenda, a top official said Wednesday. 

“We are contemplating and eager for discussion on how we might create either transparency or standards for a minimum amount of reimbursement to actually flow to the direct care workforce versus all sorts of other things,” said Dan Tsai, CMS deputy administrator and director of the Center for Medicaid & CHIP Services. 

“That would be something that we are contemplating that would be a framework that would apply across the country with respect to Medicaid,” he added. 

Tsai’s comments regarding direct care spending came following a roundtable discussion on nursing home reform the agency held Wednesday in downtown Chicago. CMS leaders detailed the approach they are taking toward implementing nursing home reform measures, which they described as a high priority for the Biden-Harris administration. 

CMS Administrator Chiquita Brooks-LaSure said that staffing is a major focus for the agency and its plans to still issue a proposal on a minimum staffing measure within the next year. Providers meeting with top federal health officials have also stated their concerns about staffing shortages with hopes of receiving additional federal support to address the issue.  

Brooks-LaSure added that the agency is strongly considering tying incentive dollars for nursing homes to quality improvements. However, she added that the agency also first wants more transparency on how federal funding is being spent. 

“One of the things that you’re hearing in this conversation is for us to have a better sense of where the dollars are going. I would say that’s where we are first starting with having more transparency,” Brooks-LaSure said. 

Refocusing surveys

She added CMS is “moving in an additional direction to make sure the dollars that are being spent are going to direct care.” Brooks-LaSure specifically highlighted Illinois’ new plan passed by lawmakers last week that boosts funding for nursing homes by $700 million and ties that increase to staffing improvements.

Similarly, New York passed legislation that requires providers to spend a minimum of 70% of revenue on direct care — with at least 40% of that going to direct care workers.

“We welcome more conversations with the industry to better understand how dollars are being spent,” she said. “I love that Illinois is talking about linking those dollars to value, and we will continue to explore whether there are additional changes that need to be made [on the federal level].”

The way federal surveyors inspect nursing homes during certifications also may be among changes CMS is eyeing, said Jonathan Blum, CMS’ principal deputy administrator and COO. 

“What the COVID pandemic showed us is that our approach to how we think about survey certifications needs to be refocused,” Blum said. “We need to focus more on where we have the greatest risk for patient harm [and] help facilities support workers who are trying to better care for their patients.”