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Biden-Harris administration takes additional steps to strengthen “nursing home safety & transparency”



Doug Beardsley
By Doug Beardsley  |  January 20, 2023  |  SNF/NF providers




The Centers for Medicare & Medicaid Services (CMS) has announced two new actions to be implemented in January (outlined in QSO-23-05-NH):
  1. Adjusting quality measure ratings: CMS will be conducting audits of schizophrenia coding in the Minimum Data Set data, and, based upon the results, adjust the Nursing Home Care Compare quality measure star ratings for facilities whose audits reveal inaccurate coding
  2. Posting citations under dispute: To be more transparent, CMS will now display citations under informal dispute on the Nursing Home Care Compare website

“President Biden issued a call to action to improve the quality of America’s nursing homes, and HHS is taking action so that seniors, people with disabilities, and others living in nursing homes receive the highest quality care,” said HHS Secretary Xavier Becerra. “No nursing home resident should be improperly diagnosed with schizophrenia or given an inappropriate antipsychotic. The steps we are taking today will help prevent these errors and give families peace of mind.”

CMS to reinforce safeguards against unnecessary medications & treatments
Beginning this month (January), CMS will conduct targeted, off-site audits to determine whether nursing facilities are accurately assessing and coding individuals with a schizophrenia diagnosis. Facilities selected for an audit will receive a letter explaining the purpose of the audit, the process that will be utilized, and instructions for providing supporting documentation. During the audit process, facilities will have the opportunity to ask questions and seek any clarification needed. Additionally, at the conclusion of the audit, the facility will have the opportunity to discuss the audit results with CMS. 

If an audit identifies that a facility has a pattern of inaccurately coding residents as having schizophrenia, the facility’s five-star quality measure rating on the Care Compare site will be negatively impacted. For audits that reveal inaccurate coding, CMS will downgrade the facility’s quality measure ratings to one star, which would drop their overall star rating as well. CMS will monitor each facility’s data to determine whether they have addressed the identified issues. After that, CMS will decide whether any downgrades should be reversed.

CMS to post citations under dispute on Care Compare  
Separately, CMS plans to take a new step to increase the transparency of nursing facility information by publicly displaying survey citations that facilities are disputing. Currently, when a facility disputes a survey deficiency, that deficiency is not posted to Care Compare until the dispute process is complete. This process usually takes approximately 60 days; however, some cases can take longer.

While the number of actual deficiencies under dispute is relatively small, they can include severe instances of non-compliance such as immediate jeopardy (IJ) citations. This level of citation occurs when the health and safety of residents could be at risk for serious injury, serious harm, serious impairment, or death. Displaying this information while it is under dispute can help consumers make more informed choices when it comes to evaluating a facility. This new information will begin appearing on Care Compare on January 25, 2023. While the citations will be publicly displayed, they will not be included in the Five-Star Quality Rating calculation until the dispute is complete. 

These two new initiatives are being implemented as part of the continuing efforts under President Biden’s initiative to improve nursing facility transparency, safety and quality, and accountability. 




Doug Beardsley  |  Vice President of Member Services  |   dbeardsl@careproviders.org  |  952-851-2489


 


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