Trump Administration Strengthens Oversight of Nursing Home Inspections to Keep Patients and Residents Safe

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

That’s the title of the Press Release dated October 17, 2019. Administrative Memo – Admin Info: 20-02-ALL was also posted that same day.  The Administrative Memo (154 pages in length, including the updated SPSS guide for FY2020) reflects that “CMS is releasing revisions to the process used to oversee state survey agency performance for ensuring Medicare/Medicaid certified providers and suppliers are compliant with federal requirements to improve and protect the health and safety of Americans.”

“Every year, CMS conducts a formal assessment of each State Agencies’ (SAs’) performance relative to measures included in the SPSS program. CMS works with the SAs to strengthen oversight so that the care provided in nursing homes and/or by providers and suppliers is of the highest quality.

In April 2018, CMS launched an initiative to evaluate the SPSS process and identify ways to improve how we monitor and ultimately the SA performance. This effort supports our goal to protect and improve the health and safety of all individuals receiving services from Medicare/Medicaid providers throughout the country. We are pleased to begin implementing changes to the SPSS in FY 2020. These changes reflect the use of improved, current datasets with consistent and objective oversight. For example, since implementing the new long term care survey process in 2017, we now have more robust data that can be used to monitor and improve performance. The changes also reflect recommendations from CMS Regional Offices (ROs) and SAs, who regularly operate the program. The resulting updates to the SPSS aim to enable CMS and SAs to address areas of concern more effectively, and ultimately improve beneficiary safety and the quality of their care. Below are the three domains of the SPSS for the 2020 fiscal year:

  1. Frequency: Conducting survey activities in accordance with required timelines;
  2. Quality: Ensuring survey agencies are properly identifying and documenting noncompliance; and
  3.  Coordination of Provider Noncompliance: Ensuring survey agencies are taking action quickly to ensure remedies are imposed for provider noncompliance.

Within these domains, we have made several changes to improve the SPSS system. Below is a summary of these changes:

  • Established State Performance Indicators that will help identify the underlying causes for inadequate performance in one or more of the scored performance measures.
  • Included survey frequency run-rates, that are directly associated with Frequency domain measures and will be useful in the assessment of the mid-year progress made towards meeting Frequency measures goals during the fiscal year.
  • Added the ability to include state specific measures, to tailor the program and address state-specific issues.
  • Improved the process by which the program operates. For example, for some performance issues SAs will be given 18-24 months to make correction, given that SAs receive their final results several months into the next fiscal year.
  • We will also be leveraging centralized data sources and hubs to access data and avoid redundant or duplicative data reporting.
  • Included a new measure for cases where immediate jeopardy is cited that indicates if the survey agency delivered the IJ template at the exit conference, per Appendix Q of the State Operations Manual. Note: SAs and ROs are now required to attach the IJ template to the survey package when uploading to ASPEN Central Office/ASPEN Regional Office (ACO/ARO) for each instance of Immediate Jeopardy.

We also plan to significantly enhance our oversight of how SAs handle complaints and facility-reported incidents (FRIs). This includes how each state prioritizes reports of abuse or neglect, the timeliness of the investigation of reports, and the quality of these investigations. We note that these issues have also been the subject of reports by the Office of Inspector General and the Government Accountability Office.  Abuse and neglect are never acceptable and CMS has included some updates in the SPSS guidance that will strengthen our oversight in this area. In addition, to ensure that SAs respond to allegations in a timely and thorough manner, CMS will be revising policies for SAs to investigate complaints and FRIs in Chapter 5 of the State Operations Manual. We will update the SPSS guidance once those revisions take place.

On behalf of CMS, we truly appreciate all the endless efforts to improve the health, safety and dignity of all Medicare and Medicaid enrollees.”

The FY 2020 State Performance Standards System Guidance, with date of October 8, 2019, comprises the remaining 150 pages of the Administrative Memo.

The Press Release as well as the Admin Info: 20-02-ALL and SPSS guide should be reviewed by all LTC stakeholders.  While the aim is oversight of State Agencies, this impacts LTC providers who are surveyed by State Agencies.  It is also interesting to read the nod to recent OIG and GAO reports on abuse and neglect and how those entities viewed CMS’ response.  This also comes days before CMS updates the Nursing Home Compare website.