Monday, August 24, 2020, the Centers for Medicare & Medicaid Services (CMS) released a Medicaid Informational Bulletin (CIB) that provides guidance to states on flexibilities that are available to increase reimbursement for nursing facilities that implement specific infection control practices, such as designating a quarantine or isolation wing for COVID-19 patients.

Nursing facilities are particularly vulnerable to the prevalence and spread of COVID-19 and states must take proactive steps to enhance infection control policies, including establishing practices to limit potential transmission, and prevent widespread outbreaks within these facilities. Today’s guidance highlights specific steps some states have taken to better support nursing facilities’ ability to safely care for all residents, including COVID-19 positive residents, and how enhanced reimbursement supported those efforts.

The CIB includes information on the Disaster State Plan Amendments (SPA) template and describes how states may use state-directed payments to increase reimbursement to nursing facilities in managed care. Today’s release encourages states to utilize the flexibilities that are available and in alignment with applicable Centers for Disease Control guidance and coordinated with the state agency responsible for nursing facility compliance.

The CIB is 5-pages in length.  Here’s a thumbnail of the categories covered in the CIB:

• Background
• Examples of nursing facility payment enhancements available to states
• Flexibilities available in managed care
• Examples of flexibilities states have implemented (3 examples are Ohio, Michigan and Iowa)

[Iowa will provide COVID-19 Relief Rate (CRR) payments to nursing facilities that either have a designated isolation unit for COVID-19 treatment or have been designated in their entirety for COVID-19 treatment (see https://www.medicaid.gov/State-resource-center/Medicaid-State-PlanAmendments/Downloads/IA/IA-20-0013.pdf).  CRR payments are an add-on payment of $300 per day to eligible nursing facilities for each resident in one of the designated units who is discharged from a hospital to the nursing facility, is pending test results for COVID-19, or has received a positive COVID-19 result. Iowa submitted a state directed payment proposal to operationalize this payment arrangement in its managed care contracts.]

• Additional Resources for nursing facilities
• Conclusion

There are numerous hyperlinks for additional information within this CIB.

CMS encourages states to utilize the flexibilities available to support the nursing facilities’ ability to safely care for all residents, including COVID-19 positive residents, during this public health emergency. CMS encourages states to do so through close alignment with applicable CDC guidance and in close coordination with the state agency responsible for survey and certification of nursing facilities.

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