Q: I heard that the Office of Inspector General’s Work Plan for 2023 includes a CMS audit of Medicaid nursing facility use of funds related to direct patient care. Should I be concerned?
A:While there is not a lot of information about this yet, you are correct. Recently, the OIG updated its 2023 Work Plan to include a planned audit of Medicaid nursing facilities’ percentage of revenue used for direct patient care.
In its summary announcing the audit, the OIG notes that improving safety, quality and transparency of Medicaid nursing facility care is a top priority for the Centers for Medicare & Medicaid Services to ensure that seniors, people with disabilities and others living in nursing homes receive reliable, high-quality care. My view is that CMS often forgets that this is also the top priority of skilled nursing facility providers as well.
The OIG notes that states have broad flexibility to establish base and supplemental Medicaid payments to providers, and this audit will focus on the percentage of revenue being expended on direct patient care. This seems to imply that states may not be assessing the effectiveness of Medicaid payments as it relates to direct patient care. It is too early to ring alarm bells as to this planned audit, but operators should certainly regard this as an issue worth monitoring.
If you are among the many providers that already track this metric, there may be even less cause for concern.
However, if you are among those who do not, I suggest you do so in case you find yourself among those included in the audit.
OIG officials said they will “judgmentally” select three facilities in selected states (one each from the following facility types: for-profit, not-for-profit and governmental) to determine what percentage of Medicaid nursing facility revenue is being expended on direct patient care.
From the January/February 2023 Issue of McKnight's Long-Term Care News
