On the heels of a report released in January of this year, the Office of Inspector General for the Department of Health and Human Services has created a series of regulatory reviews/quality initiatives for SNFs. The report focuses on the SNF experience during COVID and what, in the opinion of the OIG analysts, regulatory interventions are needed in the industry as a result of the COVID experience. The full report is here: OIG SNF Data Brief Jan 2023
I’ve written before about some of these proposed regulatory changes, the most daunting, the soon to be finalized, “staffing requirements (aka mandated staffing levels)”. The concern about the staffing mandate is not so much around a targeted number but how that number can be attained by facilities given the absence of a sufficient supply of qualified labor to meet the requirement. In other words, a mandate that can’t be met seems somewhat ridiculous. A recap for readers of what exists in the proposed SNF 2024 rule is here: https://wp.me/ptUlY-tj
The key OIG goals for SNFs for 2023, updated in May are as follows.
- Protect residents from fraud, abuse, and neglect and promote quality care. According to the OIG, enforcement actions have uncovered inappropriate/substandard care and in some cases, gross misconduct and criminality such that residents are being taken advantage of. The OIG claims that it will continue focused investigations along with the Department of Justice via False Claims Act investigations/prosecutions. Recall, it is illegal/violation of the False Claims Act to bill Medicare for substandard care. Here’s an older post that covers this topic in-depth: https://wp.me/ptUlY-kr
- Promote emergency preparedness and response efforts. This is a regulatory focus that is a direct result of the COVID report/investigation. Per OIG (and this is certainly a reality), SNFs were grossly unprepared for a public health emergency like COVID. Many did not have current emergency preparedness plans as required and fewer still, had anything substantive in their plans regarding communicable disease outbreaks.
- Strengthen oversight via state agencies. OIG claims (again, this is true) that staffing inadequacies at state survey agencies and inconsistent training and oversight has created quality risks for residents such that, oversight is not occurring as warranted via timely surveys or follow-up to complaints.
- Support federal monitoring of nursing homes to reduce risks to residents of poor/inadequate care delivery. This focus is on the role of the OIG in improving, oversight of CMS who in turn, provides regulatory oversight to the states. OIG believes it can via a focused initiative, provide more data and structure to CMS’ regulatory activity for SNFs.
The reference site for the OIG plan for SNFs is here: https://oig.hhs.gov/reports-and-publications/featured-topics/nursing-homes/