Waiving Medicaid Regulations During a Public Health Crisis: Identifying Heterogeneous Effects of Suspending Pre-Admission Screening Requirements on COVID-19 Deaths

Jason Semprini; Brian Kaskie

doi:10.31389/jltc.90

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Waiving Medicaid Regulations During a Public Health Crisis: Identifying Heterogeneous Effects of Suspending Pre-Admission Screening Requirements on COVID-19 Deaths

Journal article

Open access

Peer reviewed

Waiving Medicaid Regulations During a Public Health Crisis: Identifying Heterogeneous Effects of Suspending Pre-Admission Screening Requirements on COVID-19 Deaths

Jason Semprini and Brian Kaskie

Journal of Long-Term Care, Vol.2022, pp.15-21

01/01/2022

DOI: 10.31389/jltc.90

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Abstract

Background: During the COVID-19 Public Health Emergency, states were authorized to waive Pre-Admission Screening Resident Review (PASRR), a federal regulation requiring all individuals be evaluated before admission into a federally qualified nursing facility. We suspect states waived PASRR to reallocate resources from admission towards infection control and outbreak mitigation. However, by waiving PASRR and fast-tracking admissions, vulnerable elders may have been exposed to COVID-19 and unexpectedly placed at substantial risk for increased morbidity.Methodology: We reviewed all COVID-19 Medicaid emergency waiver requests to identify states waiving PASRR. We then analyzed daily, state-level COVID-19 deaths with a panel regression model, controlling for state and time fixed effects, and daily case rates. Finally, we expanded the model to identify heterogeneous effects shaped by market and administrative oversight factors.Results: Suspending PASRR led to significant declines in state COVID-19 deaths (–2.3 deaths per 100,000 population, p < 0.001). However, the effect waiving PASRR varied by excess nursing bed capacity (7.3 deaths per 100,000 population, p = 0.024) and historical PASRR deficiencies (0.9 deaths per 100,000, p = 0.009).Implications: Within the first month of the COVID-19 emergency invocation, nearly all states suspended PASRR, which our estimates suggest averted 7,600 deaths nationwide. However, we found that greater pre-emergency bed availability and less administrative oversight may have reduced the effectiveness of a PASRR waiver. While future research should aim to understand the mechanisms for such heterogeneity, immediate concerns relate to the variation, both between and within states, for adhering to a critical regulation protecting older adults.

covid-19

oversight

pre-admission

regulations

screening

Details

Title: Subtitle: Waiving Medicaid Regulations During a Public Health Crisis: Identifying Heterogeneous Effects of Suspending Pre-Admission Screening Requirements on COVID-19 Deaths
Creators: Jason Semprini - University of Iowa
Brian Kaskie - University of Iowa
Resource Type: Journal article
Publication Details: Journal of Long-Term Care, Vol.2022, pp.15-21
DOI: 10.31389/jltc.90
eISSN: 2516-9122
Publisher: LSE Press
Language: English
Date published: 01/01/2022
Academic Unit: Health Management and Policy; Epidemiology
Record Identifier: 9984240660302771

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