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The Centers for Medicare & Medicaid Services (CMS) has instructed state survey agencies that they must conduct onsite complaint investigations related to Emergency Medical Treatment and Labor Act (EMTALA) complaints and surveys of death in restraint or seclusion in hospitals and critical access hospitals within two business days instead of five.  This change brings these …

The Centers for Medicare & Medicaid Services (CMS) recently revised its guidance to states on standards for citing “immediate jeopardy” during surveys of all provider and supplier types and laboratories, including health, emergency preparedness, and life safety code surveys.  CMS Administrator Seema Verma observed in a blog post that the changes were made in response…

The Centers for Medicare & Medicaid Services (CMS) is requesting public comments on actual or perceived conflicts of interest that could arise when Medicare-approved accrediting organizations (AOs) also offer fee-based consulting services for Medicare-participating providers and suppliers.  Such services — which CMS points out are not currently prohibited by law or regulation — may include:…

The Department of Health and Human Services, Office of Inspector General, has issued a new Risk Alert focusing on the home health agency (HHA) survey process.  The alert specifically examined whether HHA-supplied patient lists during surveys may omit certain patients from review and thereby present opportunities to conceal fraudulent activity or health and safety violations.…

CMS is reminding Medicare- and Medicaid-participating providers and suppliers that they will be expected to comply with training and testing requirements included in a September 2016 emergency preparedness final rule by November 15, 2017.  In particular, CMS warns providers and suppliers not to wait for interpretive guidance to begin planning emergency exercises, since those who …

The Government Accountability Office (GAO) recently issued a report, “Nursing Home Quality: CMS Should Continue to Improve Data and Oversight,” examining changes in reported nursing home quality and related CMS oversight activities. According to the GAO, three nursing home data sets—standard survey deficiencies, reported staffing levels, and clinical quality measures—indicate potential improvement in nursing home quality, with the number of serious deficiencies identified per home decreasing by 41% from 2005 to 2014. Conversely, the GAO points out that consumer complaints reported per nursing home increased by 21% during the same period. The GAO contends that various data issues, such as state variations in the recording of consumer complaints and the self-reported nature of nurse staffing and quality measure data, make it difficult for CMS to assess quality trends. The GAO also discusses several modifications CMS has made to its nursing home oversight activities in recent years, such as changes to Special Focus Facility program, but observes that CMS has not monitored the potential effect of these modifications or changes in state survey agency practices on nursing home quality oversight.
Continue Reading GAO Recommends Improved CMS Nursing Home Quality Oversight

CMS has published a final rule that revises survey, certification, and enforcement procedures related to CMS oversight of national accrediting organizations (AOs), effective July 21, 2015. Among other things, the rule: revises standards for application and re-application procedures for national accrediting organizations; extends certain provisions that are applicable to Medicare-participating providers to Medicare-participating suppliers; modifies…

On April 16, 2014, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would amend fire safety standards applicable to the following types of Medicare- and Medicaid-participating health care facilities: hospitals, critical access hospitals, long-term care facilities (skilled nursing facilities, nursing facilities, and distinct part skilled nursing facilities or nursing facilities),…

The ongoing partial federal government shutdown that began on October 1, 2013 due to the government funding impasse is having a varied impact on health care provider operations. CMS has ordered Medicare Administrative Contractors (MACs) to continue to perform all Medicare claims processing and payment functions during the government shutdown. Some providers may experience the…

On April 5, CMS published a proposed rule that would revise the survey, certification, and enforcement procedures related to CMS oversight of national accreditation organizations (AOs). These revisions would implement certain provisions of the Medicare Improvements for Patients and Providers Act of 2008 that removed legal distinctions between the Joint Commission hospital accreditation program and…