Improving quality and regulatory compliance in nursing homes


Effective Compliance and Ethics Programs

Most healthcare providers are not required by current law to have broad-based compliance and ethics programs – although they are strongly encouraged.

Under Healthcare Reform, the HHS Secretary in consultation with the Office of Inspector General (OIG ) must adopt regulations requiring nursing homes (skilled nursing facilities (SNFs) and “nursing facilities”) to have an effective compliance and ethics program.  The regulations must be adopted by March 23, 2012.

Each facility’s compliance and ethics program must be “reasonably designed, implemented, and enforced so that it generally will be effective in preventing and detecting criminal, civil, and administrative violations under federal law and in promoting quality of care.”

The requirements HHS imposes in its new regulations may vary with the size of the organization that operates the facility, with larger entities being required to have “a more formal and rigorous program [that] include[s] established written policies defining the standards and procedures to be followed by its employees.” (“Larger” organizations are  defined as those that operate five or more facilities.) The statute will also require that such stricter standards must be applied to the corporate level management of multi-unit nursing home chains.

The compliance and ethics program must include …. (More)

Facilities are required to have a compliance and ethics program that conforms to the regulations in place by no later than March 23, 2013.

Three years after the compliance programs are put into place, HHS is required to evaluate the programs to determine the extent to which they have led to changes in deficiency citations and quality performance, and make a report to Congress.

Quality Assurance and Performance Improvement Program

Prior law requires SNFs and nursing facilities to have a quality assessment and assurance committee (“Committee”), consisting of the director of nursing services, a physician, and at least 3 other members of the facility’s staff, which (i) meets at least quarterly to identify issues with respect to which quality assessment and assurance activities are necessary and (ii) develops and implements appropriate plans of action to correct identified quality deficiencies.

Under the new law, HHS will establish and implement a quality assurance and performance improvement program (“QAPI program”) for nursing facilities, including multi-facility chains, by Dec. 31, 2011.  The program will establish standards and provide technical assistance to facilities on the development of best practices to meet them.

Within a year after the date on which the regulations for the QAPI program are adopted, facilities must submit a plan for how they intend to meet the standards and implement the best practices, and how they will coordinate doing so with the activities of the Committee.

Improved Handling of Complaints

HHS will develop a standardized complaint form, which the state survey agency must make available upon request to nursing home residents and people acting on their behalf, and to nursing home workers and their representatives.  This form will be provided to those who wish to file a complaint with the State survey agency and/or the State long-term care ombudsman program.  However, if the person filing the complaint does not used the standardized form (even if he makes an oral complaint), the complaint will still be attended to.

The State must establish a complaint resolution process with specified objectives and required elements as detailed here.

These provisions are slated to go into effect by March 23, 2011.

Ensuring Staffing Accountability

After consulting with stakeholder groups, the HHS Secretary will require nursing homes to submit electronically direct care staffing  information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format.

The specifications for the uniform format must include requirements that the information provided–

  • Specify the category of work a certified employee performs (such as whether the employee  is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel);
  • Include resident census data and information on resident case mix;
  • Include a regular reporting schedule; and
  • Include information on employee turnover and tenure and on the hours of care provided by each category of certified employees per resident per day.

Agency and contract staff data must be reported separately from information on employee  staffing.

This reporting obligation goes into effect no later March 23, 2012.

National Independent Monitor Pilot Program

Under the new law, the Secretary is required to establish a demonstration project  whereby an independent monitor will be appointed for a two-year period (beginning March 23, 2011) to oversee interstate and large intrastate chains of skilled nursing facilities and nursing facilities.  Participating chains…(More)

Notification of facility closure

If a nursing home plans to close, its administrator must submit written notification of the impending closure to the HHS Secretary, the State’s long-term care ombudsman, facility residents, residents’ representatives, and other responsible parties.

The notice must be provided at least 60 days prior to voluntary closure or, if closure is due to termination by the Secretary, by the date specified by the Secretary.

The administrator must ensure that the facility does not admit any new residents on or after the notification date, and the notice must include a plan for the transfer and adequate relocation of the residents of the facility by a specified date prior to closure that has been approved by the State, including assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs and best interests of each resident.

The State must ensure that, before a facility closes, all residents of the facility have been successfully relocated to another facility or to an alternative home and community-based setting.

HHS is given the discretion to continue paying the facility to care for the residents between the notification date and the day each resident is successfully relocated.

These provisions are effective on March 23, 2011.  An administrator who fails to comply with the notice provisions will be fined– a mandatory civil money penalty of up to $100,000.  At the Secretary’s discretion, he or she may also be excluded from participation in any Federal health care program.

Improved staff training

Existing requirements for initial employee training in dementia management and resident abuse prevention will be expanded. The Secretary is to determine if this should also be included in ongoing training requirements.  Effective March 23, 2011.

Ending wasteful practices of prescription dispensing

In long-term care facilities, dispensing medications in the usual 30-day supply provided to other patients can create severe administrative problems and generate enormous waste.  The healthcare reform law requires Medicare Part D prescription benefit plans and Medicare Advantage plans to establish utilization management techniques specified by the Secretary that will provide daily, weekly, or automated dose dispensing for enrollees who reside in long-term care facilities. Effective for drug plan years beginning January 1, 2012.

One Response to “Improving quality and regulatory compliance in nursing homes”

  1. 1 Natalie Heywood

    For starters, Nursing Homes should be checked up on more often without notice of an officers arrival. Having spent a lot of time visiting my Father in four different facilites whilst is Respite Care, I have not been impressed with the cleanliness or lack of, lack of carers for lengthy amounts of time (2 hours) within the secure part, amount of residents upset, wet, hurt, bruised or put outside on own where they are unable to find their way back inside. I think there needs to be more quality control!!!!

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