The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) penned a letter to Congress on Tuesday, urging legislators to replenish the Provider Relief Fund (PRF) with $20 billion for long-term care.
Half of the $20 billion infusion would go toward skilled nursing facilities, while the other half would be reserved for assisted living operators.
The organization also asked Congress to extend the public health emergency (PHE) and the Medicare sequestration delay through the end of 2022, as well as give providers more time to repay COVID-19 Medicare Accelerated and Advance Payments (CAAP).
AHCA President and CEO Mark Parkinson said while PRF has been “lifesaving” for the industry, helping thousands of facilities keep their doors open, it’s not enough. Cost and revenue shortfalls in SNFs and assisted living facilities have outpaced other sectors of the care continuum, given patient age and acuity in the case of SNFs.
Phase 4 PRF distribution covered 20% of losses for nursing homes with at least $100 million in annual net patient care revenues and 45% for smaller providers with $10 million or less in patient care revenues – coverage only covered losses in the first quarter of 2021, according to the Health Resources & Services Administration (HRSA).
“Additional aid to provide help for the remaining three quarters of 2021 is critical,” Parkinson wrote in the letter.
Q2 to Q4 of 2021 saw a significant increase to skilled nursing labor costs with no improvement to census, Parkinson added.
CAAP has helped providers with direct resources to combat COVID-19, but the timeline to repay such payments would risk losing staff and residents, and in some cases potentially shuttering facilities altogether, Parkinson said.
The program broadened the group of Medicare Part A providers and Part B suppliers to receive funds faster under a federal emergency in order to accelerate cash flow.
Parkinson asked Congress to suspend payments for six months, with recoupment allowed at 25% of all Medicare claims payments for the subsequent year.
PHE extension means an extension of crucial clinical waivers like the three-day stay waiver for Medicare patients during an “ongoing and unpredictable battle against COVID-19,” Parkinson wrote.
Parkinson also mentioned enhanced Medicaid FMAP to states as another lifesaver to SNFs.
Now is not the time to rescind helpful waivers and enhancements to the industry amid new, more contagious variants like omicron, Parkinson said. Instead, COVID-era waivers need to be reinforced to provide a “strong response” at this point in the pandemic.
“Due to the explosion of the omicron variant, coupled with the lingering delta variant, the long term care sector is in a critical and fragile time,” Parkinson wrote in the letter. “Even now, COVID-19 remains an ongoing threat as it continues to mutate while much of the world’s population and a good portion of the U.S. population remains unvaccinated.”
Parkinson also tied Covid spikes to the ongoing labor crisis, with long-term care facilities losing more than 400,000 caregivers since the beginning of the pandemic.
Workforce levels are at a 15-year low, Parkinson wrote.
Labor shortages impact access to care in the industry with operators limiting admissions at a time when hospitals need to free up bed space for patients caught up in the omicron surge.
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