Running in tandem with federal efforts to provide adequate staffing levels and better pay to certified nursing assistants (CNAs), some state officials have undergone efforts looking to achieve similar results.
Illinois House Bill (HB) 246 is making its way to Gov. JB Pritzker after state legislators on Thursday unanimously approved a $700 million increase to nursing home funding in the state, set to take effect July 1.
It’s “the most important improvement ever made to long-term care facilities in the state,” one sponsor told the Chicago Tribune. Increased funding is tied to bolstering staffing levels and quality of care, according to the measure.
The $700 million is broken down as follows: $290 million to $350 million toward staffing incentives; $70 million toward a new quality program; $83 million for CNA compensation and support workforce retention, tenure, promotion and training; $34 million to end rural reimbursement rate disparities; $52 million to transition from Resource Utilization Groups (RUG-IV) to Patient Driven Payment Model (PDPM); and $170 million to boost base Medicaid reimbursement.
Pritzker praised the passage of the bill on the House floor, Capitol News Illinois reported.
Nebraska’s lawmakers haven’t been as lucky, with Gov. Pete Ricketts this week vetoing the legislature’s proposed restoration of $52 million to increase pay for private aging service providers, according to the Lincoln Journal Star.
Ricketts opted to cut more than $100 million out of the state budget package, including funding for the skilled nursing space, to make room for tax cuts, reports said.
In response, the Nebraska legislature on Thursday successfully overrode the veto, pointing to salary hikes approved for state veterans homes, prisons and other around-the-clock facilities.
Illinois Health Care Association (IHCA) Executive Director Matt Hartman called the state move a “monumental achievement,” and a goal the association and its members have been working toward for almost two years.
“This will help long-term care centers support frontline staff in meaningful ways that our current reimbursement mechanisms do not prioritize,” Hartman said. “With these reforms, those nursing centers that have previously struggled to offer competitive wages and hire and train staff into the profession have been given the means to do so.”
LeadingAge Illinois President and CEO Angela Schnepf said the association was “humbled and thrilled” to reach an agreement with the state legislature.
“Our goal here is to improve the care of the residents of Illinois by having a Medicaid system that incentivizes staffing and outcomes while strengthening our workforce,” Schnepf said. “This compromise legislation does just that.”
An additional $225 million drawn from American Rescue Plan (ARP) funding has been earmarked for the skilled nursing sector as well – on top of the $700 million – as part of the state budget, Hartman told Skilled Nursing News.
“This isn’t finalized yet because our budget isn’t finalized yet,” added Hartman. “It’s made it through the last couple iterations of the budget so we’re pretty confident that it’s going to be there.”
Increases in CNA pay will be based on the number of years the individual has been employed in that position to reward for experience and tenure – these factors are usually “a direct correlation to quality, as is overall staffing,” added Schnepf.
Facilities would need to meet at least 70% of federal staffing level guidelines to get a bonus reimbursement; pay is based on their CMS quality star rating.
The bill maximizes the amount of federal funding to the state in Medicaid dollars, Schnepf said, and changes the tax in a way that would reduce the number of facilities to experience a loss in revenue under the new system.
An example of this is a facility providing care to a resident who no longer has funds for their care, she said.
Also in line with federal efforts, Illinois will require long-term care facilities to publicly identify all owners as part of the legislation, and plans to adopt PDPM.
The federal PDPM model was implemented in October 2019, shifting how facilities were reimbursed to serve the patients and his or her diagnoses, rather than being tied to services rendered at a SNF.
CMS sought feedback on potential parity adjustments to the new model, which increased payments to nursing homes by 5% in 2020, a total gain of $1.7 billion.
The state is giving operators an 18-month timeline to transition from RUGS to PDPM, Schnepf said, as well as to give facilities time to get to the right staffing level.
Such changes are the “first of many” the industry is likely to see in the wake of Covid, Hartman added. IHCA represents more than 450 licensed and certified long-term care centers and programs throughout the state.
Reps. Ann Gillespie (D-Arlington Heights) and Anna Moeller (D-Elgin) sponsored the nursing home bill.