Long term care facilities are raising the alarm that testing costs and a lack of new funding could push many nursing homes to the brink of financial ruin, advocates told legislators Monday.
Without action, there are worries that a rash of nursing homes will have to be taken over by the state, a process known as receivership. That could significantly hurt older Kansans without state or federal action, industry officials say.
Holly Noble, a representative from the Kansas Adult Care Executives Association, told the Joint KanCare Oversight Committee that the problem stemmed in part from testing mandates from the federal government.
The requirements, handed down earlier this summer by the Centers for Medicare and Medicaid Services, differ based off how many cases exist in the surrounding county.
For those counties in the red zone, which mandates twice-weekly testing of all staff, vendors and other personnel, costs can run upwards of $5,000 to $10,000 per round of testing.
"You’re testing your vendors, your volunteers, your staff," Noble said. "If you’re one of the larger homes you might have 500 staff members."
Costs are so high that when the federal government moved the home in Attica where Noble works from the red zone to the green zone based on updated state data the savings was significant. Homes in green zone counties only need to test once monthly.
And while the federal government pushed out testing supplies to many homes, most have run through their allowance and are having to rely on private labs.
State officials acknowledged last week that many nursing homes are struggling to access needed testing supplies and funding remained a significant concern for many facilities.
Committee Chair Brenda Landwehr, R-Wichita, said that similar constraints were not placed on hospitals.
"I don’t know why we’re putting more pressure on you to do this in the health care field because our hospitals know what they’re doing," she said.
Janis DeBoer, deputy secretary for the Kansas Department for Aging and Disability Services, said that state lawmakers elected to roll federal coronavirus relief aid initially earmarked for nursing home testing into the state’s broader testing plan.
Lawmakers charged with appropriating the money decided that the state would be better served taking an all-encompassing approach.
"It will all be folded into a collaborative initiative," DeBoer said.
But the federal testing mandates exacerbate other issues which already exist for long term care facilities, Noble said.
Facilities were already having trouble attracting staff, something compounded by the pandemic.
Twice-weekly testing requirements could lead employees to seek work elsewhere.
"I can go down the road to McDonald’s and get paid $15-an-hour and not have to worry about testing," Noble said.
And a host of uncertainties exist, such as whether Noble’s facility will be able to get their federal Paycheck Protection Program loan forgiven or not. Flu season also brings a host of new issues, including a renewed demand for personal protective equipment, which some homes are still having trouble accessing.
Ultimately, the strain could force facilities to go into receivership--which would be disastrous, Landwehr said, for a state population that is getting older
"If these facilities go under, it is not a good thing for the state to be taking them into receivership, we all know that," she said. "We’ve worked to really get out of that business because that means less care for our aging population and Kansas is a graying state."
To help ease funding woes, a whole host of providers, including long term care facilities, were set to see an increase in the rates they are paid for services rendered to Medicaid patients.
But those plans were scrapped after the pandemic, with Gov. Laura Kelly canceling out many of the reimbursement rate hikes as part of her plan to balance the state’s books.
A $9 million increase for groups which provide in-home care and disability services was among the bumps which were wiped out, according to Matt Fletcher of the advocacy group InterHab.
Many providers had already factored the increases into their budgets, he said, including raises for staff who had been on the frontlines during the pandemic.
Matt Johnstone, director of business operations for Maxim Healthcare Services, said that the proposed rate increase would still have fallen short of "where we needed to be at."
The ultimate decision to keep the rate where it was last year he said, creates even more problems for providers.
"It becomes harder and harder every year to retain and train out staff," he said. "The problem is compounded every year."
Lawmakers questioned the wisdom of the cuts, noting that the state will wind up having to pay more on the back-end if Medicaid recipients wind up in the hospital.
"We’re probably spending more than $8.9 million for hospital stays ... we’ve got to sit down and run that math to realize that we’re cutting off a foot that could be used to help in other ways because we’re using it to pay for hospital stays," Landwehr said.
Other stakeholders pushed the state to continue boosting telemedicine services, which have been used increasingly for all patients during the pandemic.
Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas said that using telemedicine to deliver mental health services had been especially valuable for Medicaid recipients.
And at a time when rates of depression, substance abuse and suicidal ideation have increased, ensuring that mental health services provided over telemedicine would be reimbursed at the same rate as those conducted in person was vital, he said.
"We hope our state will allow whatever [the Centers for Medicare and Medicaid Services] continues to allow us to do," Kessler said.
Kessler said that the mental health community would benefit from expanding the number of Kansans eligible for Medicaid, something long desired by Gov. Laura Kelly and a bipartisan group of allies but which has sunk in the legislature.
"Expansion of Medicaid will provide coverage for those who have a mental illness or mental health issues so they can access needed mental health treatment in their communities," Kessler said.