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MDH will implement a pilot for alternative complaint investigation process in SNFs/NFs

Doug BeardsleyBy Doug Beardsley, Vice President of Member Services, Care Providers of Minnesota
June 29, 2018  |  All members

Gil Acevedo, Assistant Commissioner of the Minnesota Department of Health’s (MDH) Health Systems Bureau, spoke to the Care Providers of Minnesota Regulatory Forum on Friday, June 22, 2018. Mr. Acevedo shared several updates regarding MDH, two of which are particularly important to skilled nursing facility and nursing facility (SNF/NF) operators: 
  1. MDH is committed to developing decision trees or similar tools to help SNFs/NFs be accurate in reporting under the federal reporting requirements (this may also help minimize overreporting). While a timeline has not been set for the development of these tools, Assistant Commissioner Acevedo stated it was a priority. 
  2. Beginning sometime in July, MDH will be piloting an alternative process for investigating complaints at SNFs/NFs before implementing statewide. The alternative process will involve the responsibility of the Licensing & Certification (L&C) program survey staff to conduct investigations that involve alleged violations of federal nursing facility requirements. L&C staff currently investigate federal complaints with surveys. This will include stand-alone federal complaints in the future. If the allegation also involves suspected maltreatment (neglect, abuse, and exploitation), the L&C federal abbreviated standard survey results will be forwarded on to the Office of Health Facility Complaints (OHFC) to determine if maltreatment under the Minnesota Vulnerable Adults Act (VAA) should be substantiated, unsubstantiated, or determined to be inconclusive. Federal deficiencies (and any state nursing facility licensing orders) would be issued by the L&C staff, in compliance with CMS timeframes, with any maltreatment findings issued subsequently by OHFC. OHFC will continue to issue maltreatment reports that include “a statement of any action taken by the lead investigative agency” which often includes deficiency and violation information.

Mr. Acevedo emphasized the goal was not to create a “double jeopardy” situation, and that dual on-site investigations (one L&C, one OHFC) should generally not be needed. Piloting this alternative system should give MDH the opportunity to make improvements to the system and determine when, the change will become statewide. When the system goes statewide, SNFs/NFs should anticipate seeing L&C surveyors from the various offices located around the state conducting federal complaint investigations.

Pilot and implementation will occur incrementally around the state based on staff availability and complaint workload. OHFC and L&C are working closely on this transition.  

The complaint investigation process under the Vulnerable Adults Act and for licensed-only home care providers will continue to be the responsibility of OHFC.

Doug Beardsley – 952-851-2489 – 


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