headshot - AHCA/NCAL President and CEO Mark Parkinson

Long-term care leaders are eyeing the next 18 months warily, despite recent victories in the form of better-than-expected Medicare reimbursements for fiscal 2023 and Monday’s partial reprieve on emergency nurse-aide training programs.

The likely end of the public health emergency designation will be the “big test” for the sector, said Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living. If it is pulled too soon, more providers may find themselves in financial distress or failure.

Even now, without knowing the PHE’s full future, Parkinson said in a mid-month interview with McKnight’s he foresees next year will bring “another couple hundred closures based upon past patterns. That’s because 2023 is going to be a tough year.” 

The “very big challenge” will be operating with less federal and state support when the PHE expires. Federal officials have said they will give providers at least 60 days’ advance warning before that would happen. The designation has been extended numerous times during the pandemic and is now officially extended through at least Oct. 13.

Because that’s less than 60 days away, however, healthcare leaders are confident there will be another extension, likely until at least Jan. 13, 2023. After that, Parkinson wants at least one more 90-day extension.

“What we really need is it extended for another quarter beyond then, because what that would give us is the first three months of 2023 for state legislators to really work on this issue,” he said. “Our hope is that many of the states that have had Medicaid add-ons would convert those add-ons into the base Medicaid rate

“That will be a big push of our affiliates in the first three months of 2023,” Parkinson added. “If the public health emergency ends at the very beginning of 2023 and state legislators haven’t acted yet, it’s going to be a very tough time.”

Providers have allies on the state lobbying front in Washington (and Baltimore, where CMS is based). Several times this year, CMS leaders have openly praised and prodded states’ additional assumption of oversight and funding for nursing homes.

Reform plans in focus

Next year also figures to be tough for nursing homes due to the Biden administration’s push for reform. It released a 21-point plan in late February that set the provider and patient advocate sectors abuzz. 

But Parkinson said The White House list isn’t necessarily as bad as some might believe.

“The rhetoric around the proposals was more negative than the proposals themselves,” he said. “There was all this rhetoric around the proposals that basically blamed nursing homes for the (pandemic) deaths that occurred in the buildings. That was very demoralizing to all of us, and I think it caused a lot of people to think that each of these remedies they offered must be bad.”

Parkinson explained that a “deep dive” into the 21 would show “many of those things are things we support, and have supported for a long time.”

“We’re not against (ownership) transparency or people being able to get on the Five-Star web page and figuring out who owns buildings. We’re not against people being able to figure out who owns the companies who are related to the buildings.”

He said there were approximately only four proposals that the AHCA board deemed “really bad for residents and providers.” The biggest, of course, is the prospect of “an unfunded” federal staffing minimum mandate. Another is a “massive” increase in the ceiling for Civil Monetary Penalties, which would rise to $1 million if approved. That, however, would require congressional approval and Parkinson was confident that would not be happening any time soon.

“That leaves a bunch of other topics CMS is working on, many of which we have common ground with,” he explained. “There’s a theme of working with poor providers and that poor providers don’t improve if you’re just weeding them out of the sector. 

“That’s a theme AHCA/NCAL has had for a long time, but we would approach it in a different way,” he added. “Our approach would be that we need to provide resources and tools to providers that are underperforming to get them better.”