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From Health Law Daily, February 20, 2015

Pilot nursing home survey goes national in 2015

By Harold M. Bishop, J.D.

CMS has issued a memo providing an update on the five-state volunteer pilot survey to assess Minimum Data Set, Version 3.0 (MDS 3.0) coding practices and its relationship to resident care in nursing homes. After completing the pilot, CMS announced it would expand the MDS focused surveys to all states in 2015 and would add a review of nursing home staffing to the review of resident care. According to the memo, the training for the 2015 surveys will begin in early April 2015, states will need to assign a minimum of three surveyors to be trained, training and surveys will be rolled out in two phases with regions and states assigned to one of two groups, and deficiencies identified during the surveys will result in relevant citations and enforcement actions (CMS Letter, S&C: 15-25-NH, February 13, 2015).

2015 expansion. The survey worksheets were revised by CMS based on the experiences in the five volunteer states (Maryland, Pennsylvania, Virginia, Illinois, and Minnesota). The 2015 surveys will continue to assess compliance with 42 CFR sec. 483.20 (Resident Assessment) and other applicable regulations that are identified during the investigatory process, but will also include a review of nursing home staffing to assist CMS with assessing the fluctuation of staffing levels throughout the year.

Rollout. In February 2015, CMS will inform regional offices and states regarding the group to which they are assigned. Regions and states will need to identify a point of contact (POC) to be the primary recipient of information pertaining to these surveys. Each phase will begin with training. A sample of nursing homes will be surveyed in each state.

Training. The first phase of surveyor training will begin via webinar in early April 2015. States will need to allocate two primary surveyors and one alternate to complete the training, with at least one of the onsite surveyors being a registered nurse. Regional offices should also allocate at least one individual who completes the training to serve as a POC.

In contrast to the 2014 pilot survey, the 2015 surveys do not need to be conducted by State Risk Assessment Instrument (RAI) Coordinators. CMS has restructured the survey so that it is not dependent on the use of State RAI Coordinators.

Information regarding methods for accurate completion of MDS assessments is found in the MDS RAI Manual. Additionally, Appendix PP of the State Operation Manual provides guidance on how to comply with the requirements for nursing home surveyors.

Enforcement. CMS has announced that deficiencies identified during the surveys will result in relevant citations and enforcement actions in accordance with normal and existing CMS policy and regulations. If care concerns beyond the MDS and staffing focus of this survey are identified, those concerns will be investigated during the survey or, if immediate investigation is not possible, registered with the state agency as a complaint for further review.

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