OIG tells CMS that State Agencies don’t do enough to verify compliance

In the past few years, the Office of the Inspector General (OIG) has released multiple reports related to State Agencies (SAs) not verifying correction of deficiencies identified on nursing home surveys. Those reports looked at the State Agency practices in New York, Florida, North Carolina, Missouri, Kansas, Nebraska, Arizona, Oregon and Washington. Now, in a February 2019 follow-up report, “CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs to be Improved to Help Ensure the Health and Safety of Nursing Home Residents,” the OIG called out the Centers for Medicare & Medicaid Services (CMS) for not providing more guidance on verification of substantial compliance by State Agencies. In seven of the nine states mentioned above. State Agencies did not always verify and/or maintain sufficient evidence that that nursing homes had corrected deficiencies identified during survey and sometimes maintained different practices based on Scope & Severity. As a result, the OIG recommended that CMS take action to improve State Agencies’ verification processes.

What the OIG Found

  • For deficiencies at a lower Scope & Severity (D/E/F), six of seven SAs used a nursing home’s plan of correction as confirmation of substantial compliance without having the nursing home provide evidence of correction.
  • In the states reviewed, the estimated percentage of deficiencies that verification of correction was not completed for ranged from 5% (North Carolina) to 92% (Nebraska). Washington State’s percentage was 84%, followed by New York (72%), Kansas (65%), Arizona (56%) and Florida (25%).

The CMS Guidance to State Agencies does not specify how verification and documentation of nursing homes’ corrections needs to be completed before State Agencies certify their substantial compliance with Federal requirements. CMS told the OIG that “best practice” would be for SAs to collect and retain evidence of correction of deficiencies in addition to the plan of correction, but the Guidance in the Manual doesn’t specifically state that. The OIG stated in the report that the plan of correction on its own does not serve as evidence that the SA actually verified that a facility had corrected its deficiencies and should not be used as the basis for certifying compliance. Instead, SAs can complete this verification by obtaining evidence of correction or performing a follow-up survey to verify corrections have been completed. (Supporting documentation, a footnote states, includes sign-in sheets verifying staff attendance at in-service training, interviewing more than one training participant about the training he/she has received or things such as copies of invoices/receipts related to purchases or repairs that have been made.)

CMS concurred with most of the OIG recommendations and plans to review its processes with the State Agencies and how verification should be completed. This means that we may see more follow-up visits, particularly in the previously-mentioned states. 

Read the full OIG report (A-09-18-02000) here.

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