Feds reject plan to use nursing home fines to pay for testing
It seemed like a logical and simple solution to meet the need for rapid COVID-19 testing of residents and staff at nursing homes: pay for the tests using money collected from nursing home fines.
The idea was to use millions in unused funds — including $31 million in Florida — to purchase rapid testing machines and test kits so that every nursing home could frequently, and regularly, test residents and staff, for COVID-19 infections.
The money is collected from the industry for violating federal rules on critical healthcare programs, such as infection control, and the idea to spend it on controlling the spread of the novel coronavirus was suggested by Families for Better Care, a nursing home watchdog organization.
Florida nursing home regulators liked the idea so much that Molly McInstry, deputy secretary of the Agency for Health Care Administration, asked the Centers for Medicare & Medicaid to approve using the money to do it.
The rapid tests had the potential to meet two needs: a requirement by CMS that nursing homes test staff at least every week and a new recommendation by the Centers for Disease Control and Prevention that for testing to be effective nursing homes must obtain results within 48 hours.
But last week, without warning, the idea was rejected by officials in Washington.
With 1.4 million nursing homes in the United States, “this project is denied from consideration because of lack of scalability to multiple and/or skilled nursing facilities,” wrote Leena Volmer, the regional official in charge of Long Term Care Enforcement at the Centers for Medicare and Medicaid Services in an email to Brian Lee, executive director of Families for Better Care.
Volmer, who a week before had been preparing guidelines for implementation of the idea, offered no explanation for what appeared to be a change of heart — other than to suggest the cost would be overwhelming.
In a June 16 letter to McInstry, federal officials said they rejected the plan because it was “duplicative of other federal funding streams provided during the public health emergency.”
CMS calls testing “the backbone of building a national coronavirus surveillance system” and recommends that “all staff should receive a baseline test, and continue to be tested weekly.” This week, AHCA required all long-term care facilities to test residents and staff every two weeks.
Although Florida and most other states fall far short of the CMS goal of weekly staff testing, regular testing is seen as the protective check needed to allow families and visitors back into elder-care homes.
Sophia Culley, a certified nursing assistant at Titusville Rehabilitation and Nursing Center, said she was tested a week ago and is still working every day, while awaiting the results.
“I am for testing every minute that it’s possible,’’ she said. “Because you can be tested today and the next day you can be in Orlando partying at a club or on the beach in Daytona and never know what can happen.”
Amy Runkle, a CNA at Bay Breeze Health & Rehabilitation in Venice, said testing protocols at her facility are incomplete and ineffective at catching everyone, including temporary workers who come into her facility daily.
“They’re letting most people come inside the facility with nobody to take their temperature or ask any questions,’’ she said. “You’re on your own to govern yourself. I take my temp because I want to protect myself but there’s people out there who don’t.”
Florida’s long-term care testing is being handled by the Division of Emergency Management and the Florida Department of Health and costs are being borne by taxpayers through the federal government.
“All costs associated with state-conducted testing at long-term care facilities will be submitted to FEMA for reimbursement,’’ said Jason Mahon, spokesman for DEM. Additional funding may be provided through the federal CARES Act, he said. He provided no estimate of what the program will cost taxpayers.
Administrators at nursing homes and assisted living facilities across the state have been clamoring for months for help in getting residents and staff tested as the novel coronavirus has swept through more than 700 facilities and taken 1,612 lives.
In March, the Agency for Health Care Administration followed the direction in other states and banned all visitors at nursing homes and assisted living facilities, isolating seniors from in-person visits with family and friends. In May, CMS allowed nursing homes to use the civil monetary penalty funds for grants of about $3,000 to purchase devices to allow families to have virtual visitations with residents.
According to federal data analyzed by Families for Better Care, more than $225 million in nursing home fines have been collected by federal officials over the past three years from civil penalties. A portion of these fines are returned to states so they could be reinvested back into the nursing home sector for “protecting or improving residents’ quality of care or quality of life.” In Florida, the fund is sitting on more than $31 million.
To encourage homes to do their own testing, CMS announced in April that “Medicare will pay a rate of $100 for certain laboratory tests that use high-throughput technologies to rapidly process large numbers of specimens for COVID-19 testing per day.”
The rapid testing machines would cost about half of that. Several companies produce the rapid testing machines and the FDA has set the price per test at between $40 and $50 per test, depending on a state’s reimbursement. The cost of the machines ranges from $4,500 to $6,000, meaning the cost of providing one machine for all 700 nursing homes would be between $3.1 million and $4.2 million.
“We could do a Publix BOGO deal here and we could save the industry money,’’ said Lee of Families for Better Care. “Instead they’re going to pump taxpayers for an additional $50 per test.”
Even the industry trade association, which is often at odds with Lee, is supportive of a similar idea.
“We are already experiencing increased costs with PPE, heroes pay for staff, infection control supplies and other COVID-associated costs,’’ said Kristen Knapp, director of communications for the Florida Health Care Association, a nursing home industry trade group. “If there was a way to use CMP [civil monetary penalty] funds to pay for rapid testing machines, we would certainly support the idea to help alleviate the financial burdens that ongoing testing would impose on our care centers.”
Lee is critical of the DeSantis administration’s rule this week that takes effect July 7 and bans nursing homes and assisted living facilities from allowing any staff members into the buildings unless they have been tested for COVID-19. Every two weeks, facilities will be required to test all staff, unless the staff member can provide medical documentation showing that they had previously been infected and have recovered from the virus.
“Nursing homes do not have the bandwidth to fulfill that mandate because they don’t have the testing capacity on site to be able to deliver those rapid results,’’ Lee said. “I’m not saying this solution is perfect, but if we had rapid testing in every facility we’d be a whole lot closer than what we have right now.”
Mary Ellen Klas can be reached at meklas@miamiherald.com @MaryEllenKlas
This story was originally published June 18, 2020 at 6:55 PM.
