State survey agencies ("State agencies") are required to verify that nursing homes have corrected identified deficiencies, such as the failure to provide necessary care and services, before certifying that the nursing homes are in substantial compliance with Federal participation requirements for Medicare and Medicaid. The Office of the Inspector General (OIG) recently conducted a survey, and its resulting Report says that State Agencies aren’t doing enough to make sure that nursing homes are correcting deficiencies.
Out of nine state agencies that OIG selected for review, seven did not always verify that nursing homes’ had corrected issues, as required. More specifically for 326 of the 700 sampled deficiencies, these State Agencies did not obtain any evidence of nursing homes' correction of deficiencies or maintain sufficient evidence that they had verified correction of deficiencies. For less serious deficiencies, the practice of six of the seven State agencies was to simply accept a nursing home's correction plan as confirmation of substantial compliance with Federal participation requirements without obtaining from the nursing home any evidence of correction of deficiencies.
Further, three of the seven State agencies had technical issues with maintaining supporting documentation in the software-based system used to support the survey and certification process; as a result, they did not have sufficient evidence of correction of deficiencies. The OIG report does not state clearly whether state agencies claimed to have collected any evidence, or if that supporting documentation may not have been available to the OIG.
The Report offered an example of a serious deficiency where the state survey agency did not follow up and verify the correction of the deficiency:
“A state agency completed a nursing home survey and identified several deficiencies, including a G-rated deficiency related to quality of care (42 CFR § 483.25). The surveyor noted:
- Based on observation, interview and record review, the facility failed to provide the necessary care and services . . . in accordance with the comprehensive assessment and plan of care for 1 of 4 diabetic residents . . . reviewed for medication administration. This failure occurred when the resident received too much diabetic medication and sustained a life threatening event requiring emergency medical intervention.
The state agency conducted the required follow up survey; however, it did not have documentation supporting that it had verified the correction of the deficiency.”
Resident health may be compromised. "If State agencies certify that nursing homes are in substantial compliance without properly verifying the correction of deficiencies and maintaining sufficient documentation to support the verification of deficiency correction, the health and safety of nursing home residents may be placed at risk" reads the OIG Report.
In addition, the OIG said, the Centers for Medicare & Medicaid Services’ (CMS) guidance to state agencies on such verification “needed to be improved.” Officials laid out several steps that the agency can take to respond, moves with which CMS has concurred.
LeadingAge spokeswoman Lisa Sanders told McKnight's Long-term Care News, that it agrees with the OIG’s recent findings, urging federal officials to ensure that state agencies have adequate funding to complete their reviews:
“The unevenness of surveyors’ findings and enforcement actions taken by state surveyors is well documented,” she told McKnight’s. “State survey agencies are frequently short-staffed, and turnover at these agencies is often rampant, which means that those responsible for surveying nursing homes may have neither the training nor the experience to know what they are seeing and whether conditions comply with federal standards and requirements.”
The prestigious law firm Hall, Render, Killian, Heath, and Lyman, which specializes in health-related businesses identified the following "Practical Takeaways" from the Report:
- Skilled nursing facilities should expect that state survey agencies will pay increased attention and take actions to confirm that the actions and corrections promised in a facility’s plan of correction were implemented.
- Skilled nursing facilities may see changes to the CMS forms related to the survey and certification process, such as the Forms CMS-2567, CMS-2567B and CMS-1539, so that surveyors can explicitly indicate how a state survey agency verified correction of deficiencies and what evidence was reviewed.
- Skilled nursing facilities should review and establish practices and procedures for proactively documenting the corrective actions promised for any deficiency. Facilities should have those records ready, expecting that the state survey agency will more actively confirm that the actions occurred.
As CMS reinvigorates state agencies' oversight, resident health will find greater protection.
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