State drags its feet on nursing home Medicaid terminations

ON AUGUST 3, the Baker administration sent letters to three nursing homes informing them that a series of care violations had precipitated their ouster from the state’s Medicaid program, the financial lifeline of nearly every nursing home in Massachusetts.

The letters made it sound as if residents of the three homes were in physical danger. Each letter asserted that the nursing home is “unable to safely and adequately care for MassHealth members residing at your facility, particularly in the midst of the COVID-19 global pandemic and considering the facility’s historic low-quality indicators.” Residents of the three facilities were notified of the decision.

But since that stern warning, the state has not moved swiftly to remove two of the three nursing homes from Medicaid, which would likely precipitate their closure since Medicaid typically accounts for nearly 70 percent of a nursing home’s revenues.

All three nursing homes – Hermitage Healthcare in Worcester, Wareham Healthcare, and Town and Country Health Care Center in Lowell – responded within the required 30 days to the August 3 termination letter, challenging the decision. The state rejected Town and Country’s response and that case is headed for a hearing, but the state has not even responded to the appeals of the other two nursing homes.

A six-month delay is a long time for a nursing home and its residents to live under a cloud. Officials with the Executive Office of Health and Human Services, headed by cabinet secretary Marylou Sudders, declined to comment on the cases and the delay. They also refused to release the responses of the three nursing homes or even reveal when the Town and Country hearing is being held. In response to a public records request, officials said the agency was unable to respond within the required time frame because “doing so would interfere with its other responsibilities.” The officials said a response would be forthcoming this coming Monday.

The nursing homes also declined comment.

The cases are interesting because Medicaid terminations are rare and the state’s standard for removal from Medicaid seems be somewhat arbitrary. A key factor in all three cases is the facility’s performance on a series of infection control audits conducted by the state.

Town and Country performed the worst, failing three of four audits and coming close to failing on the fourth. Only five of the state’s 362 nursing homes failed three or more audits.

Hermitage and Wareham, however, each failed only one of the four audits, joining more than 160 other facilities that failed one or more of the audits.

The termination letters raised concerns that the facilities were unable to safely and adequately care for residents during the coronavirus pandemic, but the number of COVID-19 infections and deaths at the facilities was not out of line with the rest of the industry.

The termination letters for Hermitage and Town and Country said the facilities had infection rates of 50 and 55 percent, respectively, and mortality rates of 11 percent and 14 percent. Hermitage had 69 staff and resident infections and 12 deaths; Town and Country had 39 resident infections and 12 deaths.

By contrast, the termination letter for Wareham didn’t even mention infection or mortality rates, probably because the facility has had less than 10 infections and zero deaths. Only 85 of the state’s 362 nursing homes have reported zero deaths from COVID-19, according to the state’s COVID-19 dashboard.

Damian Dell’Anno, the owner of Next Step Healthcare, which owns the Hermitage and Wareham facilities, told toldCommonWealth after receiving the Medicaid termination notices in early August that he intended to fight them. “All of the facts that they referred to in the letter of termination we can refute,” he said. “I don’t understand what the secretary [Sudders] is trying to do here.”

Dell’Anno also said the publication of the termination notice before his challenge is heard will do extensive damage to his brand. “Once this gets out, I will have utter chaos in these buildings,” he said. Next Step operates 22 other facilities in Massachusetts and a handful in New Hampshire and Maine.