President’s Budget Includes Funding for Nursing Home Reform Agenda

April 1, 2022
Policy Snapshot

Last week, President Biden released his fiscal year (FY) 2023 budget for the Department of Health and Human Services (HHS). Here are the highlights:

  • $641 million in FY 2023 for the Centers for Medicare & Medicaid Services (CMS) contracts with Quality Improvement Organizations (QIOs): Quality Innovation Network QIOs play an essential role in the department’s response to COVID-19 by providing targeted response and technical assistance to nursing homes experiencing infection outbreaks. To date, the Quality Innovation Network QIOs have trained frontline staff and managers in over 11,500 nursing homes on first-of-its-kind COVID-19 infection control techniques.
  • $200 million in infection control and vaccination uptake for nursing homes through the American Rescue Plan Act of 2021: This funding enables QIOs to combat COVID-19 in nursing homes by providing assistance to increase resident and staff vaccination rates, mitigate outbreaks, and strengthen infection control systems to prevent the entry and spread of infections.
  • $494 million for survey and certification, an increase of $97 million from FY 2022: The COVID-19 pandemic has underscored the survey and certification program’s critical oversight role for holding nursing homes and other facilities accountable to meet minimum infection control standards and protect public health for beneficiaries in these facilities from COVID-19. Building on lessons learned during COVID-19, the budget invests in improving care in long-term care facilities and improving oversight of accrediting organizations. At the FY 2023 request level, CMS projects that states will have the resources to fully complete surveys for all provider types, including complaint surveys, statutorily required surveys, and non-statutory surveys. CMS will improve oversight of nursing facilities, including an overhaul of the special focus facility program to improve care more quickly for low-performing nursing homes. These changes will make the special focus facility program requirements tougher and more impactful.

CMS has been called to establish a minimum nursing home staffing requirement; reduce resident room crowding and make single-occupant rooms the default; strengthen the skilled nursing facility value-based purchasing program by linking payment to staffing adequacy, residents’ experiences, and how well facilities retain staff; slap stricter penalties on facilities that fail to comply with quality and staffing requirements; increase financial transparency for nursing homes, including around the role of private equity investors; and allow workers to unionize and get better training. A new project in the proposed budget would build on the current requirement, that all facilities must report their staffing data and have it posted on the Medicare website and would stratify data to provide more detailed information on turnover, tenure, and staffing.

The administration is also launching new initiatives to improve nursing home quality, including the intention to strengthen requirements for on-site infection preventionists, efforts to continue bringing down the inappropriate use of antipsychotic medications, and the provision of technical assistance to nursing homes to help them improve.

Access the FY 2023 budget.