On October 5 the Virginia Joint Commission on Health Care (JCHC) staff presented a series of policy recommendations to General Assembly members on how to address nursing facility (NF) workforce challenges. The policy options address Medicaid financing, establishing a baseline staffing level, and workforce development initiatives. The report was the culmination of the JCHC’s nearly year-long look at nursing home staffing.

The report acknowledges that NF staffing and quality issues are complex and require a multi-faceted approach to addressing them. This is a very positive step to have the commission recognize these points publicly, which the association has been doing for some time.

As to the specific policy options presented, the options related to staffing requirements are of significant concern to VHCA-VCAL. They are as follows:

• Require nursing facilities (NFs) to provide 3.25 hours per resident day (HPRD) of total direct patient care (total RN, LPN, CNA hours), including at least 0.4 hours per resident day of RN care
• Require NFs to provide at least the number of expected total direct care hours and total RN hours that are calculated by CMS based on resident acuity in each NF.

Additional policy options in brief include:

• Increase Medicaid reimbursement for NFs with a high Medicaid population. 
• Fund evaluation of incentive payments for NFs that meet higher staffing levels, above the required baseline.   
• Implement workforce development programs, including loan repayment and leadership development. 
• Develop a plan to increase Medicaid reimbursement for residents with specific behavioral health diagnoses.

VHCA-VCAL has expressed opposition to the staffing-related options. Information gathered from the recent member staffing survey will help us highlight the struggle facilities are currently having to hire and retain staff needed to care for their residents. In addition, we have other concerns about the approach presented related to increasing Medicaid reimbursement for facilities with a “high Medicaid” population when overall Medicaid funding for nursing level care has been underfunded for decades. Another concerning policy option proposes a nursing facility provider tax. VHCA-VCAL has identified other issues with the information asserted in the report and is currently reviewing the report in detail.

VHCA-VCAL had regular meetings with JCHC staff during the study period and helped to facilitate visits to member centers. VHCA-VCAL issued a statement in response to the report’s release.  

Next Steps

The JCHC will meet on October 22 to hear input from stakeholders, including VHCA-VCAL, on the study findings. Commission members will also meet on November 9 to continue their deliberations on the policy recommendations. At a meeting on December 7 the full Commission will vote on the policy options, which then could be introduced as legislation in the 2022 General Assembly session.

VHCA-VCAL’s advocacy on the issues addressed in this report are a top priority for the association. VHCA-VCAL will be meeting with Commission members and other legislators to discuss ways to bolster the frontline workforce and address Medicaid funding issues.