OIG Study: HHS Watchdog Probes Enforcement Of Nursing Home Staffing Standards

Aug 30, 2020 | Research Studies of PBJ Data, Nursing HPRD & Turnover

News Digest: OIG Calls for Improved Staffing Levels & Consumer Transparency

Nursing homes’ reported staffing levels often vary on a day-to-day basis. CMS’s Five Star Rating system ranks nursing homes on their average staffing levels each quarter. As a result, daily staffing variations are not transparent to consumers.

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Some Nursing Homes' Reported Staffing Levels in 2018 Raise Concerns; Consumer Transparency Could Be Increased

Nurse staffing is a key contributor to the quality of care provided in nursing homes. This review, initiated before the COVID-19 pandemic emerged, focuses on staffing data from 2018. However, the 2020 pandemic reinforces the importance of adequate staffing for nursing homes, as inadequate staffing can make it more difficult for nursing homes to respond to infectious disease outbreaks like COVID-19.

Consumers need meaningful information about nurse staffing at nursing homes to make informed care decisions. CMS created the Payroll-Based Journal (PBJ)-a system containing self-reported provider data-to collect nursing homes’ daily staffing hours. CMS uses the PBJ data to calculate Staffing Star Ratings reported on the public Nursing Home Compare website. CMS requires a minimum number of daily hours for different types of nurses (nursing homes must have a registered nurse (RN) on staff at least 8 hours each day and licensed nurses on staff around the clock). However, CMS does not use PBJ data to enforce these daily Federal staffing requirements, nor does it regularly publish day-to-day nurse staffing on Nursing Home Compare.

READ FULL STUDY

Office of the Inspector General. “Some Nursing Homes’ Reported Staffing Levels in 2018 Raise Concerns; Consumer Transparency Could Be IncreasedDepartment of Health and Human Services, OEI-04-18-00450. 3 August 2020.

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OIG Calls on CMS to Crack Down on Nursing Home Staffing, Increase Consumer Transparency

The Centers for Medicare & Medicaid Services (CMS) should be doing more to enforce proper staffing levels at nursing homes, while providing more detailed information about nurse coverage hours to the public, the federal government’s top health care watchdog found in a new report.

About 7% of the nation’s nursing facilities failed to meet one of two key staffing requirements for at least 30 total days in 2018, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) determined; another 7% logged between 16 and 29 days with non-compliant staffing levels.

READ FULL ARTICLE

Spanko, Alex. “OIG Calls on CMS to Crack Down on Nursing Home Staffing, Increase Consumer Transparency.” Skilled Nursing News, 7 Aug. 2020, skillednursingnews.com/2020/08/oig-calls-on-cms-to-crack-down-on-nursing-home-staffing-increase-consumer-transparency.

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Nursing home staffing headed for more scrutiny

When a government watchdog decides it wants to investigate you, it’s usually not going to be content with a “No fire here, folks!” conclusion. Nobody knows that better than nursing home operators.

And so we unfold the latest Office of Inspector General investigationinto skilled nursing staff levels, which came out Monday.

In brief, nearly 1,000 operators (7%) were found to have had more than 30 days without the required amounts of nurse staffing in 2018. Also, 900 had 16 to 29 days that weren’t up to snuff. Those are pre-pandemic days, of course. But still not too early to set the stage for a little “You always were slack” blame-gaming over coronavirus carnage, if we know how this game works. And we all do.

READ FULL ARTICLE

Berklan, James. “Nursing Home Staffing Headed for More Scrutiny.” McKnight’s Long-Term Care News, 7 Aug. 2020, www.mcknights.com/daily-editors-notes/nursing-home-staffing-headed-for-more-scrutiny-again

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CMS nursing home oversight under federal probe

HHS’ Office of Inspector General is investigating the enforcement of staffing standards at skilled nursing facilities, according to a Kaiser Health News report.

1. The OIG’s investigation began earlier this month. It comes after a KHN and New York Times probe indicated some nursing homes are not meeting Medicare staffing requirements, according to the report.

2. The KHN and New York Times probe showed nearly 1,400 of the nation’s nursing homes — or 1 in 11 — have received lower Medicare star ratings for inadequate staffing levels. Nursing homes with lowered ratings did not have enough registered nurses or did not provide payroll data showing they met requirements for nursing coverage, according to a separate KHN report, which cites federal records.

READ FULL ARTICLE

Gooch, Kelly. “CMS Nursing Home Oversight under Federal Probe.” Beckers Hospital Review, 30 Aug. 2018, www.beckershospitalreview.com/legal-regulatory-issues/cms-nursing-home-oversight-under-federal-probe.html.

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HHS Watchdog To Probe Enforcement Of Nursing Home Staffing Standards

The inspector general at the Department of Health and Human Services this month launched an examination into federal oversight of skilled nursing facilities amid signs some homes aren’t meeting Medicare’s minimum staffing requirements.

The review comes on the heels of a Kaiser Health News and New York Times investigation that found nearly 1,400 nursing homes report having fewer registered nurses on duty than the Centers for Medicare & Medicaid Services (CMS) requires or failed to provide reliable staffing information to the government.

The Office of Inspector General said it would examine the staffing data nursing homes submit to the government through CMS’ new system that uses payroll records.

READ FULL ARTICLE

Rau, Jordan. “HHS Watchdog To Probe Enforcement Of Nursing Home Staffing Standards.” Kaiser Health News, 30 Aug. 2018, khn.org/news/hhs-watchdog-to-probe-enforcement-of-nursing-home-staffing-standards.

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OIG to Investigate CMS Oversight of Skilled Nursing Staffing Measures

In the wake of controversy over nationwide skilled nursing staffing levels, the health care industry’s top government watchdog has stepped in to investigate.

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) announced that it will launch a probe into the way skilled nursing facilities maintain their staffing records — with a focus on the Centers for Medicare and Medicaid Services’ (CMS) oversight of those requirements.

READ FULL ARTICLE

Spanko, Alex. “OIG to Investigate CMS Oversight of Skilled Nursing Staffing Measures.” Skilled Nursing News, 30 Aug. 2018, skillednursingnews.com/2018/08/oig-investigate-cms-oversight-skilled-nursing-staffing-measures.

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Inspector General investigating nursing home staffing: Report

A federal government watchdog is launching an investigation into enforcement of nursing home staffing standards in the wake of a high-profile New York Times report on the issue.

The Office of the Inspector General at the Department of Health and Human Services this month kicked off its examination of federal oversight related to skilled nursing facilities. This comes after a joint report from the Times and Kaiser Health News, noting that many nursing homes had lower staff levels than reported to the government.

READ FULL ARTICLE

Stempniak, Marty. “Inspector General Investigating Nursing Home Staffing: Report.” McKnight’s Long-Term Care News, 10 Sept. 2018, www.mcknights.com/news/inspector-general-investigating-nursing-home-staffing-report.

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States get needed nurse aide waiver relief but workers’ fates uncertain

Skilled nursing providers in at least 15 states averted the loss of thousands of frontline workers Thursday, when the Centers for Medicare & Medicaid Services let expire a blanket national waiver allowing the use of non-certified nurse aides. Those states had been awarded new waivers through an application process, meaning they demonstrated testing backlogs or other delays that kept providers from converting a large share of temporary nurse aides into permanent certified nurse assistants.

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CMS starts study to support minimum staffing proposal

There was a stark, though not at all unexpected, dichotomy between participants in Monday’s listening session to gather input on coming nursing home staff minimums.

On the one hand, you had consumer advocates — armed with the Biden administration’s aggressive reform push and 20 years of resentment about perceived understaffing — ready to throw fuel on the fire.

And on the other, there were nursing home leaders from major organizations, mid-sized chains and tiny, independent facilities in rural settings pleading with federal regulators to douse the flames.

Where a resident advocate might see the potential for more staffing rules to help nursing homes rise from the ashes of COVID, providers are legitimately worried that a well-intentioned but under-supported mandate might just burn the sector down for good.

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Medicaid nursing facility payment approaches

CMS encourages states to
assess their approach to payments to long-term care providers and utilize flexibilities provided
by section 1902(a)(30)(A) of the Social Security Act (the Act) in establishing Medicaid base and
supplemental payments, as appropriate, to provide adequate, performance-driven nursing facility
rates

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