After giving billions of dollars to nursing facilities from the Provider Relief Fund (PRF) “without strings,” and allowing facilities to spend the funds “without limitations,” the Department of Health and Human Services (HHS) has now announced the first round of “performance payments” to nursing facilities under PRF: $333 million to 10,631 nursing facilities, representing more than 77% of the 13,795 eligible facilities. HHS describes the performance payments as recognizing facilities “for demonstrating significant reductions in COVID-19 related infections and deaths between August and September.” HHS defines “significant reductions” as “keeping new COVID-19 infection and mortality rates among residents lower than the communities they serve, as analyzed against CDC data.”
These criteria both support the nursing home industry’s ongoing pass-the-blame argument that geography, not facility practices, determines the presence of COVID-19 in nursing facilities and undermine the argument (if facilities can take actions to reduce the spread of COVID-19, then geography is not destiny!).
HHS reports that the facilities receiving performance payments had “5,000 fewer COVID-19 infections in nursing homes in September than in August” and that 10,501 facilities (76%) had 1,200 fewer COVID-19 related deaths in September than in August. HHS identifies payments by state (identifying, by state, the total number of facilities and the total dollar payout). HHS does not identify which facilities are receiving performance payments.
The Center asks:
- Which nursing facilities will actually receive “performance payments” and how much money will each one receive?
- How many COVID cases were identified in each facility in August and in September?
- How many COVID deaths were identified in each facility in August and in September?
- Did any of the facilities getting performance payments receive an infection control deficiency in August or September?
- Has any of these facilities with an infection control deficiency in August or September had a civil money penalty imposed for the deficiency?
- How do the performance payments compare with the civil money penalties? Which are higher?
- Is HHS rewarding facilities’ “performance” at the same time that the Centers for Medicare & Medicaid Services is citing these facilities with deficiencies for infection control and imposing civil money penalties?
 In April 2020, CMS Administrator Seema Verma announced the initial payout of $1.5 billion to all skilled nursing facilities receiving Medicare (nearly all the facilities in the country) and said, “‘There are no strings attached, so the health care providers that are receiving these dollars can essentially spend that in any way that they see fit.’” Alex Spanko, “Skilled Nursing Facilities Could Soon See $1.5B Under CMS’s Emergency Relief Plan, With More on the Way,” Skilled Nursing News (Apr. 8, 2020), https://skillednursingnews.com/2020/04/skilled-nursing-facilities-could-soon-see-1-5b-under-cmss-emergency-relief-plan-with-more-on-the-way/, links to the White House press conference where Verma made this “no strings” announcement.
 CMS, “Reporting Requirements Policy Update” (Oct. 22, 2020), https://www.hhs.gov/sites/default/files/reporting-requirements-policy-update.pdf. See “Provider Relief Funds: Care for Patients or Boosting Provider Revenues?” (CMA Alert, Oct. 29, 2020), https://medicareadvocacy.org/provider-relief-funds-care-for-patients-or-boosting-provider-revenues/.
 HHS, “Trump Administration Distributes Incentive Payments to Nursing Homes Curbing COVID-19 Deaths and Infections” (Press Release, Oct. 28, 2020), https://www.hhs.gov/about/news/2020/10/28/trump-administration-distributes-incentive-payments-to-nursing-homes-curbing-covid-19-deaths-and-infections.html.