CMS Chief Verma Orders Review of Federal Nursing Home Regulations, Defends Progress So Far

The leader of the Centers for Medicare & Medicaid Services (CMS) on Monday announced a “comprehensive review” of safety and quality standards for nursing homes, while also touting the progress made in recent years.

“CMS is not waiting, and not settling for the status quo: I have directed my team at CMS to undertake a comprehensive review of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes,” CMS administrator Seema Verma wrote in a blog post released Monday. “America deserves nursing homes that ensure residents are treated with dignity and kept safe from abuse and neglect.”

Much of Verma’s post outlined oversight changes already made under her watch and the previous administration, including moves to implement stricter staffing requirements, reduce unnecessary use of anti-psychotic drugs, and more closely align reimbursements with performance — specifically pointing to the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, under which operators receive penalties for failing to improve certain quality metrics.

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But Verma also used her platform to highlight a variety of potential initiatives that CMS may adopt in the near future, repeatedly emphasizing that the federal government isn’t done overhauling its regulations for the nation’s more than 15,000 nursing homes.

For instance, Verma discussed CMS’s efforts to standardize its interactions with state survey agencies (SSAs), which have historically applied federal rules differently depending on location. Moving forward, CMS plans to establish “clear timelines” under which SSAs must report alleged abuse and neglect, and it has already streamlined its state-level guidance for determinations of “immediate jeopardy” violations.

The news came on the same day that the U.S. Government Accountability Office (GAO) released a report calling on CMS to bolster its oversight of SSAs after finding a 15-year gap in abuse investigations and reporting in Oregon nursing homes.

High-tech solutions

Verma floated the idea of more effectively rooting out nursing home staffers with histories of resident abuse, while also employing technology to more accurately track operator and patient outcomes.

“We’re exploring the possible use of Medicare claims data and associated adverse outcomes or indicators, including the use of artificial intelligence and text mining, to inform our nursing home survey and oversight process, especially for individuals transferred from a nursing home to a hospital,” Verma wrote.

CMS has also requested $442 million for survey and certification efforts in the president’s budget request to Congress, Verma noted — though the House and Senate are under no obligation to approve the White House’s plan as is. The Trump budget blueprint would also change the frequency of nursing home surveys so CMS can “continue to meet the statutory survey requirement while dealing with the increase in volume and severity of complaints, and rising survey costs,” according to Verma.

In addition, CMS is considering new ways to incorporate data about abuse improper anti-psychotic use into its consumer-facing Nursing Home Compare site; the agency already rolled out new separate star ratings for short-term and long-term care services this year. CMS has also moved to increase transparency around its assessment of nursing homes, posting notice of every agreement termination with deficient nursing homes on its website — instead of only in local newspapers — and working to make official health and safety deficiency reports easier to understand for the average consumers.

“Because these reports can be difficult for the public to understand, we’re working on ways to make them more accessible,” Verma wrote. “We want them to be clear so the public has full knowledge of the scope and severity of any problems identified during our nursing home inspections.”

Provider burdens in mind

Though Verma’s post had overall tough language regarding deficient nursing homes, she also reiterated her agency’s commitment to reducing paperwork and mitigating administrative burdens when developing new guidance and regulations for SNFs.

“High administrative costs can make it difficult for facilities to operate. In rural America, a shuttered nursing home can present serious access to care problems,” she wrote. “We are developing our regulatory strategy in a way that puts patient quality and safety first while removing unnecessary burdens on providers that create staffing challenges and increase cost without increasing quality.”

Verma’s post comes at a time of increased national coverage of nursing home safety issues, with a March hearing hosted by Sens. Chuck Grassley and Ron Wyden highlighting particularly gruesome examples of resident abuse in institutional long-term care settings.

“This is a systemic problem that does not seem to respond to whoever’s in control of any bureaucracy here,” Grassley, an Iowa Republican said during the hearing.

Individual operators across the country have also increasingly struggled to maintain quality care amid crippling Medicaid funding shortages, which have brought waves of closures, bankruptcies, and receiverships to facilities in states across the country.

Verma’s post concluded with a strongly worded warning to operators and the industry at large.

“This is not business as usual — we are pushing beyond the status quo,” she wrote. “We are focused on ensuring America’s nursing homes are keeping residents safe by rewarding quality and value, making outcomes transparent, and reducing unnecessary paperwork that detracts from patient care, and we will not hesitate to use every tool at our disposal to complete our mission.”

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