MassHealth issues termination notices to nursing homes allegedly failing to meet standards

BOSTON – Today, MassHealth issued initial termination notices to three private nursing facilities that have reportedly failed to meet the standards and requirements of the MassHealth program during the COVID-19 crisis and have a historic record of poor performance. Two of these nursing facilities were identified in the Nursing Facility Task Force’s report issued in January 2020 prior to the pandemic as chronically low quality and low volume.

The three facilities are Town and Country in Lowell, Hermitage Healthcare in Worcester, and Wareham Healthcare in Wareham. The termination notices are the first step to eliminate a provider from the MassHealth program, which could result in the facility closing.

Throughout the pandemic, the Baker-Polito Administration has developed and executed a multi-pronged strategy to support nursing homes and the residents in their care. The Administration implemented an Accountability and Support initiative, which included baseline testing of all residents and staff, constant oversight through regular infection control audits, access to personal protective equipment, and significant state funding increases along with additional federal funding.

Through this work, most nursing homes in the Commonwealth improved infection control practices and were able to address deficiencies. In the first round of infection control audits, 63% of facilities surveyed were in adherence with the initiative’s infection control standards. By the fourth round of audits, 94% of facilities were in adherence, according to the Executive Office of Health and Human Services.

According to the Executive Office of Health and Human Services, there are facilities with persistent quality concerns that remain ill-equipped to safely care for residents. These issues were further exacerbated during the pandemic and these facilities are not able to provide quality care, particularly in the event of a second surge.

Executive Office of Health and Human Services has outlined that during the pandemic, the three facilities sent notices today have:

•Demonstrated poor adherence to the most basic infection control practices during quality and infection control audits and assessments, such as failure to properly cohort COVID-positive residents and improper use of PPE,
•Had inadequate staffing ratios that jeopardized the health, safety and welfare of residents, and
•In certain cases, refused support offered by the state when dealing with substantial outbreaks and critical staffing shortages, underscoring a lack of management and judgment.

In making these determinations, the Executive Office of Health and Human Services (EOHHS) reviewed these facilities’ performance on audits and surveys, including:

•Infection Control audits conducted under the State’s Accountability and Supports initiative
•CMS-required Focused Infection Control surveys
•Historical recertification surveys

EOHHS also found that these facilities had:

•Inadequate staffing levels and hours per patient day (HPPD) below the industry standard
•Poor COVID-19 baseline testing and reporting compliance
•Lack of cooperation with state supports and audits during the COVID-19 emergency, including non-adherence to baseline testing of staff and residents and in certain cases, refusal of infection control assistance when the state had identified a need

The facilities receiving notices today will have the opportunity to respond to the noticed violations, and the right to a hearing to dispute MassHealth’s findings.

MassHealth members and families will be notified that their facility has received a termination notice and can contact the MassHealth customer service line at 1 (800) 841-2900 (press Option 3 and then Option 2) with any questions.

MassHealth will support members wishing to transfer prior to a final termination decision during a potential dispute process. Following a final termination decision, MassHealth will ensure a safe and orderly transfer of all MassHealth members out of the facility and resources will be available to support residents and families. In addition to termination from the MassHealth program, the Department of Public Health may implement an admissions freeze or other enforcement action based on the final MassHealth decision.