Under a new proposal the Indiana Family and Social Services Administration
plans to pursue in 2009, nursing homes scoring higher on their State and
Federal inspections would be rewarded with higher Medicaid payments while
those that don’t could suffer cuts. The Indiana FSSA disputes that
this is just a cost-saving measure noting that they would have pushed
for this proposal regardless of the economic condition. To effect the
plan, however, the FSSA must have the policy established through a rule-making
process that requires a public hearing and economic evaluations. That
will likely take about six months. Despite this, the discussion could
be usurped by lawmakers, who are expected to have several bills dealing
with nursing home reimbursements and inspections when they return to the
Statehouse later this month.
The Indiana Health Care Association is a group that, among other things,
serves as a lobbying mechanism for Indiana nursing homes. The Association
has cited a number of objections and proposed changes to the FSSA proposal.
Local media reported the association’s president, Stephen Smith,
as saying “[w]e completely agree with the intent [of the FSSA proposal]“.
“But we think there’s more discussion to be had about the
actual approach.” The proposal is part of a larger plan by FSSA
to adjust to weakening state revenue and put more recipients into plans
that manage health costs so that more spending is matched by Federal dollars.
The FSSA is also looking to change the way most recipients receive prescription
drugs. Currently, they are provided through the insurance companies that
operate the managed care plans and paid for by the state. With the new
approach, FSSA will take over buying and distributing drugs, thereby creating
savings of as much as $40 million annually, as Federal law gives states
big discounts for such purchases. Additionally, the FSSA will pursue a
rule that allows it to pay doctors, dentists and other health-care providers
5 percent less than the current rates. This plan, however, is only intended
to be enacted if the state appears to be headed to a deficit and the fiscal
Approximately 40,000 individuals live in Indiana nursing homes, and nearly
half of them are recipients of Medicaid. Currently, base Medicaid rates
are set by complicated formulas that take into account how much the nursing
homes spend on specific areas (such as administration and staffing), and
include specialized “add-on” services for such units as people
with Alzheimer’s disease.
The FSSA’s plan would boost the add-ons for higher-need/risk patients
and decrease the rates for those who could be served by community-based
services, such as assisted living and in-home care. It would also increase
the rates for nursing homes that receive the highest scores under the
new CMS / Department of Health report cards. These evaluations are based
on inspections that occur annually or immediately following specific complaints.
Nursing homes that do poorly on inspections would get lower rates. The
FSSA’s outgoing president was reported as saying that the FSSA was
not going to pay a premium for quality of care if the care facilities
were providing was not “actually quality”.
The Indiana Health Care Association, through its president, Stephens, said
the proposal is based on an inspection and assessment system that is “broken,
entirely subjective, and lacks a consistent quality of assurance mechanism.”
The Association intends to back a number of changes to the inspection process.
Lawmakers intend to take a look at the association’s suggestions,
but Terry Whitson, assistant commissioner for health-care regulatory services
at the Indiana Department of Health, said investigators must follow federal
guidelines — not a state system — when inspecting nursing homes.
Quoting local media reports, Whitson was heard saying, “[w]e have
over 100 nurses performing these surveys and not every one is going to
have the same mind-set all the time. There are bound to be some inconsistencies.
But all our surveyors go through federal training. Every survey is reviewed
by the [Federal] Centers for Medicare and Medicaid Services. There is
a level of consistency and fairness.”
Nursing homes vary in the quality of care and services they provide to
their residents. Reviewing health inspection results, staffing data, and
quality measure data are three important ways to measure nursing home
quality. This information gives you a “snap shot” of the care
individual nursing homes give.
One of the most important things to do is to visit the nursing homes you
are considering. If possible, also contact your Long-Term Care Ombudsman
or State Survey Agency before making a decision. Take a copy of the Nursing
Home Checklist when you visit a nursing home and talk to the nursing home
staff about the information on this website.