The Centers for Medicare & Medicaid Services has paused most grants distributed from its civil monetary penalty reinvestment program, leaving some nursing home leaders without a much-needed funding source for patient- and staff-centered programming.
CMS in a statement to McKnight’s Long-Term News this week gave no end date for potential delays related to “an ongoing comprehensive review” of the CMP reinvestment program, which began in April.
“During this review, the approval of some applications for CMP reinvestment funds may be delayed as we work to ensure the integrity of distributions, in keeping with our goal of improving nursing home resident quality of life and achieving care innovations,” the agency said through a spokeswoman on Wednesday.
The agency declined to elaborate on the reasons for its review, or what components of the largely state-driven reinvestment program it was examining. The fund doles out some of the money collected each year from nursing homes for non-compliance, allowing selected applications to use grants for resident- and family-facing programs, specialized joint staff training for QAPI initiatives and other, limited projects.
While CMS said it continues to approve grants related to COVID interventions such as air filtration systems, but Medicaid agencies in all states were notified of the delay for more general grants.
The pause has already led to frustration for providers in some states.
In Pennsylvania, the Department of Human Services had just announced its 2023 CMP grant application window when it sent a May 23 email rescinding the dates, according to the Pennsylvania Health Care Association.
“To put the impact into context, providers rely on CMP grants and other supplemental funding sources to help mitigate the chasm between what they are reimbursed and what it costs to introduce innovative programs, make needed infrastructure improvements and provide high-quality, necessary care to our seniors,” said Garry Pezzano, president & CEO of LeadingAge PA. “CMP grants offer hope to already stretched providers in Pennsylvania facing significantly heightened rate instability in addition to increased staffing requirements and workforce shortages exacerbated by high temporary staffing agency rates.”
Carol McKinley is president and CEO of Simpson, which operates three retirement communities, including a 142-bed, five-star skilled nursing facility, in the Philadelphia area.
Her small team had applied for $84,000 in CMP funds in 2022 and was asked by Pennsylvania officials to reapply this February because the original application had technically expired. Simpson was at that time informed it was one of five selected grantees under consideration, but after resubmitting, the nonprofit organization heard nothing further.
CMS never issued a memo on its grant stoppage, instead communicating directly with states on possible delays. McKinley, a LeadingAge PA board member, learned about the national delays through the organization.
Now it’s unclear whether her communities will ever get the funding to initiate Comfort Matters training for staff, which would have provided innovative skills and weekly coaching for frontline staff serving seniors with cognitive decline and dementia.
“If we’re not getting that money, then we need to think about, where else will we go? We’re not-for-profit. We don’t have a ton of resources,” McKinley told McKnight’s Thursday. “It was disappointing to us because we know this particular program will make a difference and the dollars would have supported a really, really good program for our residents and their families and our staff. I mean, particularly at a time when they’re burned out from COVID. Now, we wanted to introduce something new and exciting … and we got the breath knocked out of us because now we won’t be able to do that.”
CMS grants are already limited, with some providers critical of the lengths they must go to to apply and the frequency of denials in some states. Relatively few of the nation’s 15,000 nursing homes ever benefit.
In California, where $12.7 million is currently available in CMP grant funds, just 10 applications were submitted for the 2022-23 fiscal year, with six awards totaling $6.5 million. Nearly $4 million, however, went to a state LeadingAge initiative.
The current pause could stifle innovation and the program’s livelihood, McKinley warned
“I could have spent that time writing a grant for something else,” she said. “I don’t know if I ever want to waste my time going after CMP money again. It’s so aggravating that they let us down.”
Even a temporary pause is “most disappointing” for Rick Abrams, president and CEO of the Wisconsin Health Care Association.
WHCA was working with the state’s survey agency to develop a CMP-funded Customer Services Best Practice Education and Training program for nursing home participants. That proposal is now on hold.
And providers will remain in a holding pattern for the foreseeable future. CMS told McKnight’s only that it will issue updated guidance and information on the CMP reinvestment program through a quality and safety oversight memo “when the review is finalized.”