CMS strengthens oversight of nursing home program

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The Centers for Medicare and Medicaid Services is increasing scrutiny and oversight over the country's poorest-performing nursing facilities.

CMS is toughening requirements for completion to the Special Focus Facility Program and increasing enforcement actions for facilities that fail to demonstrate improvement.

However, currently only 0.5%, or 88 nursing homes, nationwide participate in the SFF Program. Some facilities fail to reach the standards necessary to graduate from the program, CMS said, and some facilities demonstrate improvement, only to regress.

CMS is calling on states to consider a facility's staffing level in determining which facilities enter the SFF Program. 

Specific actions include adding a threshold that prevents a facility from exiting based on the total number of deficiencies cited – no more "graduating" from the program's enhanced scrutiny without demonstrating systemic improvements in quality.

It is also considering all facilities cited with Immediate Jeopardy deficiencies on any two surveys while in the SFF Program for discretionary termination from the Medicare and/or Medicaid programs.

CMS is imposing more severe, escalating enforcement remedies for SFF Program facilities that have continued noncompliance and little or no demonstrated effort to improve performance.

The agency is extending the monitoring period and maintaining readiness to impose progressively severe enforcement actions against nursing homes whose performance declines after graduation from the SFF Program.

Additionally, CMS is advising State Survey Agencies to consider a facility's staffing level, in addition to its compliance history, when selecting candidates from their state for inclusion into the SFF Program. 

WHY THIS MATTERS

CMS said the announcement is part of a series of new actions to increase accountability of bad actors in the nursing home industry, improve the quality of nursing homes and make them safer.

The changes are designed to incentivize facilities to quickly improve their quality and safety performance, allow the SFF Program to scrutinize more facilities over time by moving facilities through the program more quickly, and promote the sustainability of facilities' improvements to ensure they do not regress post-program.

These changes will help drive improvements to resident care, CMS said.

While the revised SFF Program increases scrutiny and enforcement consequences for poor-performing nursing homes, CMS is also emphasizing a number of efforts facilities can take to support quality improvement, including engaging the CMS Quality Improvement Organizations and hiring external consultants to support performance improvement. 

CMS is encouraging facilities to make good-faith efforts (and provide evidence of these efforts) to improve quality and measurable changes, such as changes in staffing, leadership or increased overall staffing. These efforts will be considered when evaluating potential enforcement actions for noncompliance. 

For example, SFFs with noncompliance and no evidence of good efforts to improve quality will be subject to more severe enforcement sanctions, such as higher penalties, or the suspension or termination of federal funding.

THE LARGER TREND 

The action fulfills a promise laid out in President Biden's State of the Union Action Plan for Protecting Seniors by Improving Safety and Quality of Care in the Nation's Nursing Homes to overhaul the SFF Program to strengthen scrutiny over more poor-performing nursing homes, improve care for the affected residents more quickly, and better hold facilities accountable for improper and unsafe care, CMS said. 

Since its inception, the SFF Program has identified the poorest-performing nursing homes in the country for increased scrutiny to rapidly make and sustain improvements in the quality of care they deliver. These facilities continue to be inspected roughly twice as often as all other nursing homes – no less than once every six months – and face increasingly severe enforcement actions if improvement is not demonstrated. 

Facilities must pass two consecutive inspections to complete the program.  

ON THE RECORD

CMS Administrator Chiquita Brooks-LaSure said, "Poor-performing nursing homes have the opportunity to improve, but if they fail to do so, the changes we are making to CMS' Special Focus Facilities Program will hold these facilities accountable for the health and safety of their residents."
 
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org