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GAO Recommendations to HHS will Enhance Abuse Reporting & Data

The Government Accountability Office (GAO) issued its list of priority open recommendations for the Department of Health and Human Services (HHS) on April 23, 2020. The document includes ten areas with 55 priority recommendations. One section of particular importance is the public health-related programs and issues section. Two areas covered in the document relate to abuse and neglect in nursing homes.

Abuse and neglect prevention and reporting has been a major focus of the Centers for Medicare & Medicaid Services (CMS) in recent years. Whether it was putting the controversial “abuse flag” on Nursing Home Compare or announcing its Five-Part Plan to ensure safety & quality in nursing homes, CMS has been making changes to the way nursing homes are regulated, surveyed and information is provided to the public. The following GAO recommendations and the information provided by HHS in response to the recommendations show the expanding focus on abuse prevention.

Enhancing the CMS Database on Abuse-related Information

In its June 2019 review document, “Nursing Homes: Improved Oversight Needed to Better Protect Residents from Abuse,” GAO recommended that CMS should require information provided by State Agencies regarding abuse to include more specifics. This includes providing information on the type of abuse and the perpetrator type to allow CMS to identify survey trends about abuse in more detail. HHS stated that this process was underway and that CMS should be able to identify these trends by December 2020.

State Agency Referrals to Law Enforcement

The GAO noted that it recommended to CMS Administrator Seema Verma in June 2019 that when State Agencies are investigating a complaint or conducting a survey and surveyors have reasonable suspicion to believe that a crime has been committed against a nursing home resident, the State Agency should immediately take appropriate action. This includes either immediately referring the complaints to law enforcement or during survey, referring the information to law enforcement once identified. This recommendation came as part of the review document mentioned above and represents an additional step towards helping to prevent abuse in nursing homes.

This was expected to be implemented in February 2020, but now this requirement is expected to be implemented by December 2020. GAO states that since regular surveys of nursing homes are temporarily paused due to COVID-19, that there is a decreased likelihood that abuse will be identified by surveyors, and thus, it is important to implement this recommendation to close potential gaps in CMS oversight related to abuse.

View the April 23, 2020 GAO Priority Open Recommendations: Department of Health and Human Services letter on the GAO website.

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