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  1. Congress Poised to Vote for Harmful Balanced Budget Amendment
  2. Home Health Highlight: New Fact Sheet – Medicare Home Health Coverage In Light of Jimmo v. Sebelius 
  3. Nursing Home Roundup:

Congress Poised to Vote for Harmful Balanced Budget Amendment

As early as today, the House of Representatives plans to vote on a Balanced Budget Amendment (BBA) to the Constitution that would prohibit federal spending from exceeding federal revenues.  (For a history of such efforts to “make deficits unconstitutional” see, .e.g, this Vox article.)  In a letter to Congress, the Center for Medicare Advocacy joined the Medicare Rights Center in expressing opposition to this or any balanced budget amendment to the Constitution (also see a letter in opposition from the Leadership Council of Aging Organizations).  As noted by Reuters, the majority in the House is pushing for the BBA “despite passing tax cuts in December that are projected to add $1.9 trillion to the national debt over the next decade.”  Passage of the BBA would lead to dramatic cuts in federal spending and would undermine essential, bedrock programs such as Medicare and Social Security that most American families rely on.  This effort must be stopped.


Home Health Highlight: New Fact Sheet – Medicare Home Health Coverage In Light of Jimmo v. Sebelius

With support from the John A. Hartford Foundation, the Center for Medicare Advocacy provides the following Fact Sheet to help Medicare home health beneficiaries and their families respond to unfair Medicare denials based on an erroneous “Improvement Standard.” The Fact Sheet emphasizes language from the Jimmo Settlement Agreement, wherein the Centers for Medicare & Medicaid Services (CMS) agreed to revise the Medicare Benefit Policy Manual to clearly disavow any notion that a recipient of Medicare-covered home health care must improve in order for his or her skilled nursing or skilled therapy services to be covered by Medicare.  Skilled nursing and therapy are Medicare-covered services.


Nursing Home Roundup:

1. Nurse Staffing in Nursing Homes:

Beginning in April 2018, the Centers for Medicare & Medicaid Services (CMS) will begin using Payroll-Based Journal (PBJ) staffing data to determine each facility’s staff rating on Nursing Home Compare. All facilities must submit staffing data each quarter on “the number of hours staff are paid to work each day of that quarter.”[1] The goal of the requirement is to provide better public reporting of each facility’s staffing practices in a manner that is auditable based on payroll “and other verifiable sources.”[2] Prior to the PBJ requirement, a facility’s staff rating on Nursing Home Compare was based on self-reported data and was susceptible to greater manipulation by some facilities.

The transition to PBJ data is also accompanied by staffing data audits. According to the CMS memorandum announcing the transition, “CMS and its contractors have begun conducting audits aimed at verifying that the staffing hours submitted by facilities are aligned with the hours staff were paid to work over the same timeframe.”[3] When these audits result in a finding that a facility’s PBJ data is significantly inaccurate or incomplete, CMS will presume that the facility has low staffing levels, resulting in a one-star staffing rating and a reduction of the facility’s overall star rating.[4]

Similarly, beginning July 2018, a finding that the facility failed to have a registered nurse on duty as required by law (eight hours a day, seven days a week), for at least seven days each quarter, will also result in a one-star staffing rating on Nursing Home Compare.[5] CMS’s memo adds that, based on PBJ data for the third quarter of 2017, about six percent of facilities had seven or more days without a reported RN and 80 percent of those days were on weekends.[6]

2. CMS Transitions to Payroll-Based Journal Staffing Data on Nursing Home Compare

House Energy and Commerce Committee Chairman Greg Walden, Subcommittee Chairman Gregg Harper, Subcommittee Chairman Michael Burgess, and member Gus Bilirakis voiced their concerns over media reports of nursing home resident harm in an April 2, 2018, letter to CMS Administrator Seema Verma. The letter states that “[t]hese reports raise serious questions about the degree to which the Centers for Medicare & Medicaid Services (CMS) is fulfilling its responsibility to ensure federal quality of care standards are being met…”[7]  The Congressmen add that the adequacy of CMS’s oversight of skilled nursing facilities has also been “called into question” in reports by the HHS Inspector General and the Government Accountability Office (GAO).[8] 

The Congressmen specifically point to the tragedy that occurred in Florida, where 14 residents of the Rehabilitation Center at Hollywood Hills died after the facility’s air conditioner lost power during Hurricane Irma. Raising the link between ownership and poorly performing facilities, the Congressmen note that this is not the first time that the facility’s owner has been “scrutinized by the federal government.”[9] Previously, the owner entered into a settlement agreement with the Department of Justice in a civil case regarding kickbacks and medically unnecessary treatments that were performed on “elderly beneficiaries to generate Medicare and Medicaid payments.”[10] Even more recently, another one of the owner’s facilities was found to have 30 violations, including “sexual assault of patients, low staffing, and ignoring patients.”[11]

The Congressmen have asked CMS to provide the Committee with information about CMS’s role overseeing nursing homes, including the Rehabilitation Center at Hollywood Hills and any other facility linked to that facility’s owner.

[1] Transition to Payroll-Based Journal (PBJ) Staffing Measures on the Nursing Home Compare tool on and the Five Star Quality Rating System, CMS (April 6, 2018),
[2] Id.

[3] Id.
[4] Id.
[5] Id.
[6] See id. (noting that “[a]s the number of RN hours increases, so does performance on . . . quality measures”).
[7] Letter from Greg Walden et al. to Seema Verma (April 2, 2018),
[8] Id.

[9] Id.
[10] Id.
[11] Id.





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