CMS nursing home oversight under federal probe

HHS' Office of Inspector General is investigating the enforcement of staffing standards at skilled nursing facilities, according to a Kaiser Health News report.

Six things to know:

1. The OIG's investigation began earlier this month. It comes after a KHN and New York Times probe indicated some nursing homes are not meeting Medicare staffing requirements, according to the report.

2. The KHN and New York Times probe showed nearly 1,400 of the nation's nursing homes — or 1 in 11 — have received lower Medicare star ratings for inadequate staffing levels. Nursing homes with lowered ratings did not have enough registered nurses or did not provide payroll data showing they met requirements for nursing coverage, according to a separate KHN report, which cites federal records.

3. The OIG said it would examine CMS oversight of nursing facility staffing levels. More specifically, it said it would look at nursing staffing levels reported to the Payroll-Based Journal, auditable daily staffing data CMS uses to examine staffing patterns and determine average staffing ratings at nursing homes. The payroll records represent a new approach to calculating average staffing ratings at nursing homes, as required by the ACA. Medicare payroll records now provide data on staffing levels at nursing homes. Previously, such evaluations had been based on unverified, self-reported data from facilities.

4. The OIG said: "We will examine nursing staffing levels reported by facilities to the Payroll-Based Journal and CMS' efforts to ensure data accuracy and improve resident quality of care by both enforcing minimum requirements and incentivizing high-quality staffing above minimum requirements."

5. A report with the OIG's findings is expected to be released in the federal fiscal year that begins in October 2019.

6. CMS declined to comment to KHN about the new probe. The publication previously reported that CMS acknowledged challenges with reporting data for salaried staff in the payroll system, which focuses on reporting hourly work, but said nursing homes were notified in April of potential downgrades if they showed no registered nurses on the clock.

Read KHN's full report here.


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