In April 2024, the Centers for Medicare & Medicaid Services (CMS) described in a single paragraph a shorter “more focused survey” for up to 10% of a state’s nursing facilities that provide “consistently higher quality” care. The sole justification for the new risk-based survey (RBS) process that CMS was already testing was the fact that the federal survey budget had been flat since 2015. See Alert and May 15, 2024 letter to CMS Administrator Brooks-LaSure, drafted by the Center for Medicare Advocacy, raising questions and concerns about RBS.
CMS’s response – a letter dated October 17, 2024 from Dora L. Hughes, Acting Director, Center for Clinical Standards and Quality, Chief Medical Officer, CMS – justifies RBS on the same flat budget basis. Dr. Hughes writes that CMS has authority to develop RBS and that CMS is testing the process in at least 20 states and will validate the results.
CMS’s April description of “consistently higher quality” facilities that would be eligible for RBS was notably weak:
Higher quality could be indicated by a history of fewer citations for noncompliance, higher staffing, fewer hospitalizations, and other characteristics (e.g., no citations related to resident harm or abuse, no pending investigations for residents at immediate jeopardy for serious harm, compliance with staffing and data submission requirements).
Advocates’ April letter expressed concern about this limited description, citing decades of reports by the General Accounting Office documenting the undercoding of deficiencies as less serious than they are, the 2% of facilities cited with immediate jeopardy, the vague “higher staffing” criterion, and more.
Dr. Hughes did not directly address advocates’ concerns and suggestions about the criteria for determining whether facilities are eligible for RBS, writing that CMS would “consider” them. She noted, “regardless of the criteria or RBS process, if there are any concerns related to resident care that are identified, surveyors will expand the survey and will not exit the facility until all concerns related to resident safety are addressed.”
October 24, 2024 – T. Edelman