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Trump Administration Strengthens Oversight of Nursing Home Inspections to Keep Patients and Residents Safe

Trump Administration Strengthens Oversight of Nursing Home Inspections to Keep Patients and Residents Safe
CMS announces enhanced oversight of State inspectors and the inspection process, responding to growing concerns about consistency and timeliness of inspections

Today, the Centers for Medicare & Medicaid Services (CMS) announced a major step in the Agency’s efforts to ensure safety and quality for nursing home patients and residents. As part of continuing efforts to keep nursing home residents safe and respond to concerns about inconsistent and untimely inspections, CMS is strengthening the system it uses to hold inspectors accountable, the State Performance Standards System (SPSS). Nursing homes are inspected by State Survey Agencies (SSAs), and their inspections protect patients and residents by ensuring nursing homes comply with federal safety guidelines. Under the changes announced in a memo to states today, CMS will, through the updated SPSS assessment tools, more rigorously and rapidly analyze SSA performance to ensure inspections are timely and accurate. This includes new performance measures and stricter monitoring to ensure inspections are done in a fair, accurate, and timely manner, ensuring patient safety, and ensuring that enforcement actions – like civil money penalties – are applied consistently. This action is the latest example of CMS delivering on its five-part plan to ensure safety and quality in the nation’s nursing homes – specifically strengthening oversight.

“Nursing home patient and resident safety is a top priority for the Trump Administration. Abuse and neglect are never acceptable,” said CMS Administrator Seema Verma. “After careful study of State inspector performance, CMS is taking action to increase oversight of inspectors and ensure States are conducting thorough and appropriate inspections. Our action today delivers on the “Strengthening Oversight” pillar of our five-part approach to ensuring safety and quality in nursing homes. By holding inspectors accountable for conducting timely and consistent inspections, we’re holding nursing homes accountable for providing safe, high-quality care – helping ensure safe nursing home environments.”

Specific changes to the SPSS announced today include:

• Increased monitoring – through new metrics that are reviewed more frequently – to assure SSAs are conducting surveys in a timely manner;

• New “State Performance Indicators” that will be reviewed quarterly to help identify potential issues with respect to SSA performance, helping CMS address problems before they worsen. Previously, CMS had examined each State’s performance on a set of long-standing measures after the close of the fiscal year. These new Performance Indicators include metrics to provide information related to citation rates and the timeliness of complaint investigations, to allow for quick mitigation of issues;

• Holding SSAs accountable for correctly handling cases in which health and safety are in immediate danger, a situation called “immediate jeopardy (IJ),” by formally measuring the timeliness of SSA notifications of IJs to facilities, and the accuracy of that notification. This follows previous CMS guidance to help SSAs identify and cite situations threatening immediate harm encountered during inspections;

• Also, considering increased system flexibility for CMS to add State-specific measures to help CMS target resources to poor performing SSAs. For example, a State experiencing specific problems with the complaint investigation process could employ a measure related to the complaint investigation process. This flexibility will help States focus on any specific challenges they face in their work to keep patients and residents safe; and

• Better access for SSAs to centralized CMS data to avoid redundant or duplicative data reporting and unnecessary administrative burden on SSAs, helping them focus on their work to inspect nursing homes for compliance.

Today’s action to strengthen oversight of nursing home inspections are just the latest in a series of important actions the Trump Administration has undertaken to safeguard residents. In April, CMS Administrator Verma announced a five-part approach to ensuring safety and quality in nursing homes. The approach includes the following pillars: Strengthen Oversight, Enhance Enforcement, Increase Transparency, Improve Quality, and Put Patients Over Paperwork.

CMS has been consistently delivering on this five-part approach for nursing homes – and improving oversight across other settings of care. Just a few weeks ago, CMS announced plans to increase transparency by providing consumers an easy-to-understand alert icon on the Nursing Home Compare website, which indicates past instances of abuse, neglect, or exploitation. Similarly, in oversight of other healthcare settings beyond nursing homes, CMS recently streamlined and improved performance reviews of the State agencies that inspect clinical laboratories with the goal of safer and more reliable care for patients receiving lab services.

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