Nursing home manual changes bring more scrutiny

Nursing homes should brace for more intense scrutiny and stiffer penalties in the wake of the Health Care Financing Administration’s (HCFA) Dec. 14 release of revisions to its State Operations Manual. HCFA’s instructions to state agencies require immediate sanctions against nursing homes in more situations, including any time a nursing home is found to have caused harm to a resident on consecutive surveys.

HCFA’s guidance includes the use of a new enforcement tool that allows fines of up to $10,000 for each serious incident that threatens residents’ health and safety. In the past, fines could only be based on the number of days that a nursing home failed to meet federal requirements.

"There is a lot of room for concern here," says Marie Infante, a health care attorney with Pyles, Powers, Sutter and Verville in Washington, DC. "Facilities are really going to have to pay very close attention to these initial survey reports and the letters that accompany them."

Infante says the revision is a refinement of HCFA procedures largely based on the administration’s own initiatives and Senate Special Comm ittee on Aging Chairman Charles Grassley’s (R-IA) insistence that the agency must tighten its enforcement processes. The new rules become effective Jan. 14.

"They have taken some procedural actions that are going to significantly step up the enforcement timetable and allow them to impose swifter penalties on nursing homes," says Infante. She says that will include civil monetary penalties and some transfer of enforcement authority from the federal government to the states.

Previously, HCFA’s regional offices were responsible for issuing payment denials and new admissions based on recommendations from the state. Now states themselves will be vested with that authority.

There are new safety rules

According to Infante, there is also a new lengthy chapter about safety issues and a new set of guidelines for state survey agencies. The latter includes measures HCFA will use to monitor survey performance as well as the actions it will take in cases of inadequate survey.

The revision also enhances Nursing Home Compare, HCFA’s consumer Internet resource, to include information about the prevalence of bedsores, weight loss, and other health conditions among residents in individual nursing homes.

Those actions follow other steps taken by HCFA earlier this year to strengthen the state inspection and enforcement process:

• HCFA instructed state inspectors to increase their focus on preventing bedsores, malnutrition, and abuse in nursing homes.

• HCFA established a new requirement for states to focus on complaints alleging harm to residents and conduct investigations within 10 days.

• States now must conduct more frequent inspections of nursing homes that have repeated serious violations without decreasing inspections of other facilities.

• State inspectors now must make the timing of inspections unpredictable and must conduct some visits on weekends, early mornings and nights to look for quality, safety, and staffing problems at those times.