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Payment Plan for Nursing Homes Raises Concerns

California is embarking on a campaign to improve the way patients are treated in nursing homes.

The state is developing a plan to link $40 million in Medi-Cal rate increases to standards of care in nursing homes. Higher Medi-Cal payments, scheduled to start next summer, would be awarded to nursing homes receiving top marks in several categories, such as nurse-to-patient ratios, minimizing physical restraints and preventing bedsores.

State officials also propose setting aside some bonus money for nursing homes that don’t meet standards but have shown dramatic improvement.

Some patient advocates say the proposed standards aren’t high enough. Others say the state must also include punitive measures for nursing homes that fall short. Others worry that the financial rewards may be paid out without actually improving the level of care in California’s nursing homes.

In addition and related to the Medi-Cal rewards program, state officials will be dealing with other facets of nursing home oversight. A health care budget trailer bill signed by Gov. Arnold Schwarzenegger (R) included the reauthorization of AB 1629, which details oversight for the state law that requires nursing homes to maintain minimum staffing and spells out penalties if they don’t.

We invited experts to weigh in on how stakeholders, including providers and state officials, should interpret and implement these new regulations aimed at improving care in California’s nursing homes.

Officials from the California Department of Health Care Services declined to participate, saying the timing was not good. They plan to unveil the specifics of their Medi-Cal reimbursement plan “sometime shortly after Nov. 30.”

We got responses from:

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