In a new report, New Jersey’s Acting State Comptroller identifies the 15 consistently lowest-performing nursing facilities in the state and recommends implementing changes to the Medicaid program that would require these facilities, in a phased enforcement approach, to improve or be barred from receiving Medicaid reimbursement.[1] The report is similar to a legislatively-mandated task force report in Massachusetts that, in 2020, recommended that the Department of Public Health be given “more explicit statutory authority to revoke the licenses of chronic underperformers in quality and occupancy.”[2] Advocates for residents agree with both the New Jersey Comptroller General and the Massachusetts Task Force that facilities that repeatedly fail and deliberately refuse to provide good care to residents should be excluded from public funding. Owners and operators of chronically poor quality facilities should be barred from owning and operating facilities. Residents deserve better care than they are receiving.
The New Jersey State Comptroller defines the 15 lowest quality nursing facility as facilities that had one-star ratings in the first quarter of each month in six of the last eight quarters in 2020 and 2021. These 15 facilities provide care to approximately 1,850 Medicaid beneficiaries, 6.5% of the Medicaid beneficiaries in New Jersey nursing facilities, and receive an average of $103 million from the Medicaid program for the care they provide. The State Comptroller finds that 14 of the 15 poorest-performing facilities are operated on a for-profit basis and that their owners/managers/third-party administrators are connected with multiple facilities that are the poorest performing and a total of 39 New Jersey nursing facilities. The Comptroller General recommends that “The New Jersey Medicaid program should use its authority to protect current and future residents of LTCs by linking eligibility in the Medicaid program to improvements in ratings.”
The Massachusetts Task Force found that 18 facilities (5% of Massachusetts’ total) were both chronically low quality (1 or 2 stars or Special Focus Facilities) and had unsustainably low occupancy rates (less than 80% in 2019). The Task Force found that “rates and market forces are not enough to preserve quality nursing homes” and that the Department of Public Health should strengthen its licensing process for reviewing the suitability of applicants.
The Center for Medicare Advocacy agrees with the Comptroller’s and Task Force’s recommendations that facilities (and, we would add, owners, managers, and related parties) that fail or refuse to provide acceptable levels of care to residents should be barred from receiving public funding.
February 10, 2022 – T. Edelman
[1] New Jersey Office of the State Comptroller, “An Examination of the Lowest-Rated Long Term Care Facilities Participating in New Jersey’s Medicaid Program, Medicaid Fraud Division” (Feb. 2, 2022), https://nj.gov/comptroller/library/reports/LTCs/LTCs%20Report%20FINAL.pdf
[2] Nursing Home Task Force (Jan. 31, 2020), https://www.mass.gov/doc/nursing-facility-task-force-final-report/download