Nursing home residents face eviction

Wednesday, June 7, 2000 | 11:09 a.m.

CARSON CITY -- A number of nursing homes in Nevada will be "downsizing" in the next six months, evicting up to 800 elderly, a legislative committee was told Tuesday.

Representatives of Integrated Health Services, Inc., which operates 15 nursing homes in Nevada, blamed the state's payment policy for part of its problems and said the company has had to write off $5.5 million in losses over the last three years for care they provided Medicaid patients.

Integrated Health Services is in bankruptcy protection nationwide. Tammy Subchak, administrator of the Cheyenne Care Center in Las Vegas, which is part of the company, said the national firm will be reducing its operation in Nevada, meaning some 200 patients in Las Vegas and 600 elderly in Northern Nevada would have to find other care.

Subchak said the firm "will be downsizing operations in the state. It will be focusing on eliminating buildings, which are not financially viable, which include buildings that primarily care for Medicaid patients."

The facilities could close "within 90 days to six months at the outside," Subchak said.

"You have a crisis. Elderly citizens are going to be displaced," Tom Hathaway, administrator of Washoe Care Center in Sparks, told the Legislative Committee on Health Care. The state in its Medicaid program is paying anywhere from $30 to $100 less a day per patient than the operating costs.

"A nursing home company can't be subsidizing Nevada," Hathaway said.

Committee members were concerned these elderly patients would be left without care or a home.

Assemblywoman Vivian Freeman, D-Reno, suggested a letter be sent to the governor in an effort to straighten out the dispute between the nursing homes and the state Department of Human Resources over Medicaid reimbursement.

"If these (nursing homes) close, we will have to pick up the costs," Sen. Maurice Washington, R-Sparks, said.

And Sen. Bernice Mathews, D-Reno, said this problem has a "human face" -- somebody's mother or grandmother will be put out on the street."

State Human Resources Director Charlotte Crawford said the state "is not trying to evade payment on Medicaid." But it must go through an orderly process in handling these financial matters. She said the state was willing to work with nursing home operators to resolve the problem.

Tuesday's meeting was the first the state knew about the $5.5 million in losses that Integrated Health Services claims, Crawford said, adding that she did not have the information to determine whether the nursing homes were entitled to some of that money.

But Washington called Crawford's statement "false." He said he was in a meeting with state and nursing home administrators and that $5.5 million write-off figure was disclosed.

Dallas Adams of Integrated Health Services based in Las Vegas, said there are two problems. Nursing home operators must submit their bills within 120 days while many other states allow up to one year to ask for payment.

Adams said there may be an error by the nursing home or the state. Correcting those errors delays the submission date. Sometimes the submission goes past the 120-day deadline, he said.

Half of the errors are made by the state, he said. "But the burden of the errors fall on us and pushes us over the 120-day rule."

But Crawford said extending the time for submission of bills from 120 days to one year would cost the state an extra $6 million to $6.5 million a year. "It's not a simple change. It's a budget impact."

Crawford and Janice Wright of Health Care and Financing said the nursing homes are paid within 30 days after the claim is submitted. Wright said however there are instances where payments take longer.

Adams also complained about the "two strike" rule where the state will not accept any claim where the nursing home has made two errors. The rule is unfair because some problems are caused by the state not communicating.

The state's Medicaid system is not automated, resulting in a "paper intensive system" prone to human errors and delays, Adams said.

Wright said the 1999 Legislature authorized the agency to start planning for a new computer system, which will take about seven years to develop and cost $25 million, with 90 percent coming from the federal government.

Adams and Subchak suggested the state extend its billing cycle to one year from the present 120 days and eliminate the two strike rule.

The committee took no action but suggested the two sides meet.

Adding to the financial problems of the nursing homes, Adams said is a state law that prevents the eviction of patients who have no ability to pay. One patient alone has cost a nursing home about $120,000.

The patient may be eligible for Medicaid, but the family or guardian refuses to give financial information to the state to allow payments to be made to the home.

"The facility gives a 30-day notice of eviction if there is no payment or assistance in getting Medicaid established," Adams said.

"The state ombudsman then steps in and denies discharge due to no safe place to discharge," he said, leaving the nursing home footing the bill.

The state should be more aggressive in its attempt to get the cooperation of the family and guardian, Adams said, adding that the nursing homes should have the ability to attach property or payments going to the patient.

"The facilities need the state to reimburse for all care given when they deny us the right to discharge the patient," Adams said.

About 37 percent of the free standing nursing homes in Nevada are in bankruptcy court, Crawford told the committee.