ST. THOMAS — For 19 people living in Sea View nursing home in the rehabilitation unit, things could not look worse. At a District Court hearing held on Friday, a federal judge said they the nursing home probably won’t have its Medicare reimbursements restored.
Funding was cut July 30, one year after Sea View was decertified by the U.S. Centers for Medicare and Medicaid Services. At a hearing held on July 29, District Court Judge Curtis Gomez said he could find no other instance in the country where federal health insurance payments continued so long after certification was lost.
The extensions were made possible by a settlement reached between nursing home owners, the VI government and CMS. They were based on promises the government made to take over the facility, make improvements in safety and operations by a given date.
But that didn’t happen.
The evidentiary hearing on Friday was held to give Sea View owners, Human Services and the Department of Property and Procurement one last chance to prove CMS acted in bad faith when they terminated Medicare reimbursements on July 30.
But at the end of the hearing the judge said after numerous hearing and opportunities given, the parties failed to show where CMS did not live up to its side of the bargain.
“The breach that is complained of is hard to discern from the record,” Gomez said.
As a result, the 19 residents, ages 56 to 104, are subject to the options offered by CMS. To continue receiving Medicare and/or Medicaid reimbursement, they will have to move to another approved skilled nursing facility.
The problem is, there is no other skilled nursing home in the Virgin Islands.
Temporary Sea View Manager Myrna Wynn said from her years of experience as a nursing home manager in Boston, most patients moved long distances died. “Once they are relocated they don’t seem to survive more than six months,” Wynn said.
The other prospect is that they stay in the Virgin Islands, as the administration of Gov. Kenneth Mapp vowed to do.
At the end of Friday’s hearing Sea View Administrator Adeline Connor said the management has been contemplating its next steps. Without Medicare reimbursement, Sea View can continue to operate on funding from the local government but that funding makes up 45 percent of its operating funds.
Medicare reimbursements make up 55 percent of funding, she said. A major cash crunch, but not the first.
When decertification happened at the end of June 2015, Connor said a drop in population in the rehabilitation unit produced a corresponding drop in revenue.
Now vendors are currently working on a cash only basis and the prospects of providing continued care to the residents with those limitations, she said, would be very challenging. At times when funds are not enough to cover cash on delivery, Connor said food vendors have packed up the goods and put them back on the truck.
Gomez pointed out that based on testimony given at two hearings in July, CMS administrators said they would act swiftly to restore reimbursements if certain conditions were met.
Those conditions included removing the current owner, leasing the property out to the VI government and putting certified nursing home manager in place. CMS also required that Sea View’s fire suppression system either be repaired or replaced and that regular fire drills be conducted by the staff.
Nursing home administrators said they got as far as gathering estimates for the work — roughly $81,000. But the judge said those required steps didn’t happen, despite promises from a special advisor to Gov. Kenneth Mapp and Human Services Commissioner Vivian Ebbesen-Fludd that they would.
Officials displayed, “no sense of urgency,” Gomez said. He gave the parties until Monday to produce evidence or statements proving CMS acted in bad faith and thereby committed a breach of contract on the codicil.
“If there isn’t that collective and shared intention, there will not be a resolution short of judicial termination,” Gomez said.
Nursing home attorney Mark Hodge told the court that CMS raised the bar on placing a temporary nursing home manager by March 24 after CMS rejected the candidate the agency presented on March 23. The rejection, Hodge said, left Sea View administrators scrambling to find a suitable replacement. One was identified, approved and put in place by May 30.
Evan Shulman, CMS director for its Nursing Home Division explained in court several reasons why the decision to reject the candidate was made. “That person did not have the qualifications of someone who had managed a nursing home of this type. CMS also noted that this person did not have a license, but that was not the reason we rejected the candidate,” Shulman said.
Placement of the temporary manager was a condition set for continuing Medicare reimbursements past March 30. Federal authorities allowed funds to keep flowing in spite of the fact that Sea View was decertified by CMS on June 30, 2015.
Hodge tried to argue that the residents faced dire consequences if compelled to move. Gomez called for evidence to support the statement, but the nursing home lawyer showed none. The only evidence appearing to relate to the point was presented by the judge. It appeared in a letter to Sea View from CMS, saying that if any of the residents died after being relocated, their bodies would not be returned to the Virgin Islands at CMS expense.