STATE SURVEY AGENCIES FALL SHORT IN VERIFYING FACILITIES PLANS OF CORRECTIONS

State Survey Agencies Fall Short In Verifying Facilities Plans of Corrections – What does this mean and why it is of concern for the residents of our over 15,000 nursing homes?

The Office of the Inspector General of the US Department of Health and Human Services issued a report dated Feb 7, 2019* which indicated that the oversight agencies responsible for conducting state survey of skilled nursing facilities of 7 states, of 9 states reviewed, did not regularly or adequately verify that identified deficiencies were actually corrected as stated in  the plans of correction. The 7 states that did not consistently verify the corrections were: Arizona, Florida, Kansas, Nebraska, New York, North Carolina and Washington.  It also found that the Centers for Medicare and Medicaid Services (CMS) did not provide appropriate guidance to the regulatory state agencies on how to verify these corrections and deemed that maintaining the documentation which supported that the deficiencies were corrected needed improvement. This is obviously of serious concern for all nursing home residents and patients, affecting their health, safety and well-being.

When a skilled nursing home facility receives their annual department of health survey areas that do not meet the standards of care are identified as deficiencies. Deficiencies can fall into

Categories affecting standards of care and services. An example of a serious deficiency would affect the quality of care. Failure to meet the standards of care indicates that the facility is not in compliance with Federal regulations as set forth by Medicare and Medicaid, the two federal sources from which the facility receives reimbursement. Once the survey is completed and the report is issued, it Is up to the facility to address the areas of deficiency and devise a plan to address and correct each of the identified areas.

In preparation of this report, the Office of the Inspector general took a sampling of 700 deficiencies that were identified. Of those 700, the report found that for almost half (326), the oversight state agencies did not verify the corrections of serious deficiencies. For deficiencies that feel into a category that were less serious, 6 of those same 7 states, accepted the nursing home’s correction as corroboration that the corrections were indeed put into practice and, thus, the facility was in substantial compliance with the federal guidelines.

The report cited a particular example of a serious deficiency whereby 1 of 4 residents who were diabetic received too much diabetic medication which resulted in a life-threatening situation necessitating emergency medical attention. In many cases, a state agency is required to conduct follow up survey to ensure deficiencies have been corrected. Though that was done in this particular case, there was no documentation to verify that the deficiency was corrected.

The report concluded that the Centers for Medicare and Medicaid Services take specific actions to improve their guidance to state survey agencies in how to go about verifying corrections of deficiencies, establishing oversight, and maintaining technical support of documentation of corrections.

As a result of the Office of the Inspector General report, and the mandate to the Centers for Medicare and Medicaid Services to improve that their oversight state agencies do a better job ensuring that the corrective measures proposed by skilled nursing facilities are actually put into practice, it is hoped that skilled nursing facilities will feel the need to be more accountable in implementing their plans of correction. They should be able to see that their correction measures more closely examined and be able to provide documentation to that effect. It is only through this process that we can assure higher standards of care and services for our loved ones.

*Report titled: “CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs to Be Improved to Help Ensure the Health and Safety of Nursing Home Residents” https://oig.hhs.gov/oas/reports/region9/91802000.pdf