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The article discusses the challenges faced by New York's long-term care facilities in meeting the state's minimum staffing requirements and the potential consequences of a national staffing mandate imposed by the Centers for Medicare & Medicaid Services (CMS). Industry leaders are calling for increased funding, particularly for Medicaid reimbursement rates, to help address the workforce shortage.

Some key points from the article include:

• New York's long-term care facilities are struggling to meet the state's minimum staffing requirements due to a severe workforce shortage.
• The state's Medicaid reimbursement rates are not sufficient to cover the costs of staffing, leading to difficulties in recruiting and retaining staff.
• Industry leaders are calling for increased funding, particularly for Medicaid reimbursement rates, to help address the workforce shortage.
• A national staffing mandate imposed by CMS could exacerbate the problem if it does not take into account the unique challenges faced by different states.
• Some potential solutions include allowing medication technicians to work in long-term care facilities and offering scholarships for nurses.
• New York's Assembly Bill A10515, which adds five different therapy roles to the state's staffing mandate, is seen as a step in the right direction.

The article quotes several industry leaders, including Stephen Hanse of LeadingAge New York and Michael Clyne of the New York State Health Facilities Association. They highlight the need for increased funding and flexibility in staffing requirements to address the workforce shortage.

Overall, the article suggests that a one-size-fits-all approach to staffing mandates may not be effective in addressing the unique challenges faced by different states, and that policymakers should consider the specific needs of each state when developing regulations.

The article discusses a bill in Illinois that aims to reform the state's Medicaid reimbursement system for skilled nursing facilities (SNFs). The bill, which is being monitored by analysts at Mizuho Securities USA, could potentially impact the patient-driven payment model (PDPM) and introduce bundled payments.

The Illinois bill differs from President Biden's call to expand value-based payment (VBP) measures in that it includes a funding mechanism. A tax tied to the bill would generate around $500 million for increased Medicaid reimbursements. The bill combines funding and paying for performance together, which is seen as a key aspect of its potential success.

The Illinois Health Care Association (IHCA) has been working on aspects of the bill for about six years and has been collaborating with the state on different iterations of the bill for two years. The association's executive director, Matt Hartman, expressed optimism that the legislature would pass the bill by April 8.Other stakeholders, including LeadingAge Illinois, have also expressed support for the bill. Angela Schnef, president and CEO of LeadingAge Illinois, noted that the initial bill had almost doubled the amount of money coming into the state to help those on Medicaid.

The article highlights the potential risks associated with changes to the payment model, including the possibility of re-introducing bundled payments. However, it also notes that the Illinois bill's combination of funding and paying for performance could be a key factor in its success.

Overall, the article suggests that the Illinois bill is an important development in the ongoing efforts to reform Medicaid reimbursement systems for SNFs, and that its outcome will be closely watched by industry stakeholders.

The Centers for Medicare & Medicaid Services (CMS) has finalized a staffing mandate for nursing homes, requiring them to meet minimum staffing standards. The rule, which is set to be published on May 10 and go into effect on August 9, mandates a minimum of 3.48 hours per resident per day (HPRD) of total staffing, with specific allocations for registered nurses (RN) and nurse aides.

CMS officials acknowledged that some nursing homes may struggle to meet the requirements, leading to potential closures or waivers. However, they emphasized that the current status quo of inadequate staffing is unacceptable and has resulted in poor quality care. The agency plans to implement the rule in three phases, with the first phase beginning within 90 days of publication.

The rule allows for some exemptions, including facilities located in areas with a low RN-to-population ratio or those that can demonstrate "good faith efforts" to hire and retain staff. However, these exemptions are limited in scope and temporary, and providers will be required to report information quarterly if they avail themselves of the exceptions.

Despite the phased implementation and exemptions, nursing home advocates have expressed concerns about the financial and logistical hurdles to enforcing the mandate. The federal government has allocated $75 million for nurse training, but advocacy groups consider this amount inadequate. Additionally, a KFF Health News analysis found that nearly 80% of nursing homes would not meet the minimum staffing standards.

CMS plans to partner with states to bolster nurse recruitment and will use existing survey processes to enforce the requirements. The agency also expects other states to join in funding the program, which is still being developed.

The finalized rule has been met with opposition from industry leaders, who have called it an "extinction event" for nursing homes. However, CMS views the exemptions and phased implementation as a way to ease the growing pains of the mandate.

Here is a summary of the article "Avoid these ‘gotchas’ in PBJ reporting" by Don Feige:

The Centers for Medicare & Medicaid Services (CMS) has indicated that mandatory Payroll-Based Journal (PBJ) submission will not be delayed, with the first submission due on November 14. To ensure compliance, skilled nursing facilities must navigate several complex rules and definitions outlined in the CMS PBJ Policy Manual. One of these "gotchas" is the "Midnight Split," which requires direct care hours to be recorded on the calendar day they occurred, even if a shift spans multiple days.

Another challenge is ensuring that staffing data includes pay type and job title for each employee, rather than just listing the employee's name. Facilities must also capture all direct care hours, including those provided by agency or contract staff, and use a reasonable, auditable methodology to calculate these hours. Tracking agency and contract hours can be particularly difficult, but options include obtaining data from vendors, capturing it in timekeeping systems, or using vendor management software.

To stay PBJ compliant while managing costs, facilities must evaluate their current systems and processes, make necessary changes, and potentially invest in workforce software that can create PBJ reports. The article concludes by emphasizing the importance of staying on top of compliance deadlines, with key milestones including July 1 (start of data collection for 4th quarter reporting) and September 30 (last day of collecting 4th quarter reporting data).