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First Round of HHS “Performance-Based” Payments Released

Medical healthcare and doctor service
Tiffany Karlin

October 29, 2020

In early August we released an alert detailing the President’s plan to allocate funds in early September to nursing homes. The President’s plan is to allocate $2.5 billion to upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs and another $2 billion to create an incentive program.  The five payment cycles will be based on quality performance to reward nursing homes for keeping new COVID-19 infection and mortality rates among residents down.

American Health Care Association’s Proposal of Possible Payment Plan:

The first round of the incentive program compared data is from the months of August to September. 10,631 nursing homes are being awarded, as they met the infection control criteria. This data shows that 77% of the 13,795 eligible nursing homes met the criteria. Click here for the official data from the HHS.

The awarded nursing homes were responsible for 5,000 fewer COVID-19 infections and 1,200 fewer COVID-19 related nursing home deaths in September than in August.

How were the facilities measured?

Facilities have their performance measured on two outcomes:

  1. The overall COVID-19 infection rate among residents.
  2. Performance for COVID-19 mortality among residents.

Performance measurements for each facility will be evaluated based upon the population-wide rate of COVID-19 infection in the geographic area in which a facility is located. The goal is to appropriately evaluate facility performance by measuring the baseline level of infection in the facility’s geographic location.

In order to measure facility COVID-19 infection and mortality rates, the incentive program will use data from the National Healthcare Safety Network (NHSN) Long-term Care Facility Component COVID-19 Module. Within the NHSN module, the program will incorporate weekly reported data on COVID infections, COVID mortality, and the total count of occupied beds.

In addition, admissions of COVID-19-positive patients will be considered in order to focus accountability on infections acquired among existing residents. Using this weekly information, each facility will receive measurements of their COVID-19 infections per resident and COVID-19 deaths per resident in each performance month.

In order to measure the baseline infection rate, the program will use weekly updates of data included in CDC’s Community Profile Reports (CPRs). Data from the CPRs include county-level information on total confirmed and/or suspected COVID infections per capita, which will be used to measure the baseline infection rate for all eligible facilities located in that county.

When will funds be received?

It is projected that nursing homes will receive September quality incentive payments the first week of November. There will be four more opportunities to receive additional incentive payments.

How can funds be used?

Like the first round of “infection control” targeted distribution, the Nursing Home Infection Control Distribution can only be used for the infection control expenses defined in the Terms and Conditions. This includes costs associated with administering COVID-19 testing for both staff and residents; reporting COVID-19 test results to local, state, or federal governments; hiring staff to provide patient care or administrative support; incurring expenses to improve infection control, including activities such as implementing infection control “mentorship” programs with subject matter experts, or changes made to physical facilities; and providing additional services to residents, such as technology that permits residents to connect with their families if the families are not able to visit in person.

Terms and conditions of the funding.

Click here to sign the attestation.

Click here for a state-by-state breakdown on incentive payments from this first cycle.

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