AHCA Update on CMS Regulatory Issues

Karen Morris and Nancy Leveille in Clinical & Quality

CMS provided AHCA with updates on a variety of topics relevant to SNFs and NFs:

  1. QAPI:  Abt Associates is working with CMS on further development of QAPI.  Abt is convening several Technical Expert Panels that will be making recommendations about a) how plans of correction can be aligned with a QAPI approach; 2) how to help surveyors and others reconcile the tension between the overall survey/regulatory process (including regulations and guidance) and QAPI; and 3) how to involve patients and families with QAPI.  AHCA is represented on one of the TEPs by Mary Ousley, who will provide us with updates moving forward. 
  2. CMP Analytical Tool:  CMS continues to analyze the information obtained since the implementation of the CMP Analytic Tool in April 2013.   They report a slight uptick in per-day versus per- instance CMPs; and a slight uptick in the total number of CMPs imposed.  CMS believes the tool needs additional work related to how facility culpability is factored into the amount of a CMP that is imposed and  how to refine the tool to create more consistency related to the start date of a CMP (primarily in cases of past noncompliance).
  3. Draft S&C Memo regarding Abuse:  Many of you will recall that in March 2012, CMS requested AHCA to provide comments on a draft S&C Memo that was intended to “clarify issues related to the Federal requirements for abuse, neglect, mistreatment and misappropriation of resident property for nursing homes.”  AHCA had serious concerns with elements of the draft and following discussion with members and receiving written comments from members, we submitted extensive comments to CMS.  Additionally, there were several discussions with CMS about this draft memo.  The CMS Office of the General Counsel (OGC) then began review of the memo. The memo has now been cleared by the CMS OGC and will be issued soon – according to CMS, “hopefully sometime in February.”  CMS has not shared with us the content of this S&C Memo.  We are hopeful that AHCA’s comments in 2012 will have resulted in an S&C Memo that is more reasonable than the initial draft.
  4. E-POC’s:  CMS continues to work on implementing Federal electronic plans of correction.  The initial phase-in is occurring  in several states and regional offices.  During the phase-in, CMS is working with states that already have electronic plan of correction requirements and attempting to design the federal system to interact with the state systems.
  5. Egg Safety:  CMS is developing an S&C Memo that will provide additional guidance related to “egg safety” in nursing centers.  The issue date of this memo is uncertain.
Director, Clinical & Quality Services
518-462-4800 x15
  Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20