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CMS releases memo to survey agencies regarding sequestration

On April 5, CMS released a memo titled “FY2013 Sequestration Adjustments for Survey & Certification (S&C)” to all state survey directors.

According to the memo, CMS is making certain adjustments to S&C operations to accommodate sequestration with as little impact on the public as possible.

In regards to long-term care, one of the updates focuses on Special Focus Facility (SFF) nursing homes. For nursing homes that have exhibited a persistent pattern of poor quality and have been enrolled in the Special Focus Facility initiative, CMS asks its surveyors to:

  1. Schedule a final “last chance” onsite survey for those facilities that have been on the SFF list for more than 18 months and have failed to improve. The scheduling of the survey may coincide with the next planned onsite survey, or be advanced in accordance the extent to which State monitoring continues to indicate lack of significant progress. After discussion with the CMS regional office, a Medicare termination notice may be issued if the onsite survey does not reveal appropriate improvement or unless there is a major new development that CMS concludes is very likely to eventuate in timely and enduring improvement in the quality of care or safety.
  2. Review the progress of all other facilities that have been on the SFF list for more than 12 months. CMS staff will discuss with the SA the status of each facility and plan further action.
  3. Do not, until further notice, select a replacement SFF nursing home when a current SFF facility has been terminated from Medicare participation or has improved to the point of graduating from the SFF list, unless directed to do so by the CMS regional office.

The effect of this adjustment will be to (a) speed final resolution (preferably substantial improvement) of the issues with these nursing homes where serious problems have persisted for a considerable time, and (b) continue the SFF initiative (consistent with sections 1819(f)(8) and 1919(f)(10) of the Social Security Act), but at a temporarily reduced number of facilities.

The memo also focuses on Life Safety Code (LSC) in nursing homes. It states that with respect to the LSC portion of the nursing home survey:

  1. We are making available, at State option, a Short Form survey that surveyors may use to assess compliance with key life-safety code requirements for those nursing homes that CMS determines have a consistently good track record of LSC compliance in the past, provided the nursing home is also fully-sprinklered. CMS will provide a list to each SA regarding the facilities that may qualify for the Short Form survey. There will be no option for use of the Short Form for a facility that is not 100% fully sprinklered.
  2. States electing this option for the identified facilities will be required to provide some basic information to CMS CO so that we may evaluate the results of this option.
  3. A Short Form LSC survey was available prior to 2006 but discontinued. Certain targeting and quality controls will apply to the use of the Short Form survey option.

CMS has instructed survey directors to implement these policy changes immediately.

Read the memo here for more details.