Nursing Home Staffing Issues Take Center Stage at Post-Acute Work Group Meeting

November 25, 2020

Staffing issues across the health care continuum were the focus of WHA’s Post-Acute Work Group at its Nov. 20 meeting. Work Group members discussed how the lack of open nursing home beds constrains a hospital’s ability to discharge patients who need that level of care. Nursing home beds may be unavailable because either an outbreak in the facility prevents admissions or because the facility doesn’t have enough staff to keep beds open.
WHA staff described efforts currently underway to address these staffing shortages and detailed recent Department of Health Services (DHS) initiatives that have impacted bed availability in nursing facilities to which hospitals seek to transfer some of their patients ready for discharge.
After hearing from some member hospitals bordering Minnesota that could not find skilled nursing facility (SNF) placements for their patients, WHA contacted DHS about the feasibility of discharging Medicaid patients to nursing homes in Minnesota. DHS said this would be permitted if a Minnesota-based or another border-state provider is enrolled in the Wisconsin Medicaid program. If it is not, it may apply for enrollment, and its eligibility will be retroactive as long as the border-state nursing home is certified as a Medicaid provider in its home state. The border-state provider will be reimbursed at its state’s nursing home reimbursement rate.
WHA is also pursuing swing bed reimbursement under Wisconsin Medicaid as another way to expand nursing home bed access. WHA proposes that Medicaid reimbursement be provided to critical access hospital swing beds, as well as to prospective payment system hospitals that apply for the Medicare swing bed program as permitted under federal COVID-19 waivers. This proposal is in progress.
WHA staff also reviewed DHS’ respiratory outbreak policy described in the September 24 issue of The Valued Voice. This guidance resulted in restricted admissions to nursing homes. Subsequent DHS guidance outlined a process that provides some flexibility in admissions facilities in the event of an outbreak.
DHS recently authorized federal CARES Act funding for nursing homes to incentivize admissions of hospital patients. This funding, explained in the November 12 Valued Voice, will provide $80 million of CARES Act funding to nursing homes. Noteworthy to WHA members is $30 million allocated to a skilled nursing facility post-acute care admission incentive program. This program will offer a $2,900 payment for every admission a nursing home receives directly from a hospital, backdated to cover the last two weeks of October until funds are expended or through Dec. 30, 2020, when the CARES Act funding expires. This will help meet DHS’ statewide response goal of boosting the number of staffed SNF beds that can accept hospital discharges. 
For further information on WHA’s Post-Acute Work Group and the topics discussed in this article, contact WHA’s Laura Leitch or Laura Rose.

This story originally appeared in the November 25, 2020 edition of WHA Newsletter