OIG to tackle skilled nursing payments, avoidable hospitalizations in FY 2016

The Department of Health and Human Services Office of Inspector General will dig into Medicare requirements for skilled nursing care coverage during the remainder of fiscal year 2016, according to a n
The Department of Health and Human Services Office of Inspector General will dig into Medicare requirements for skilled nursing care coverage during the remainder of fiscal year 2016, according to a n

The Department of Health and Human Services Office of Inspector General will dig into Medicare requirements for skilled nursing care coverage during the remainder of fiscal year 2016, according to a new report.

The OIG's FY 2016 Mid-Year Work Plan, published Tuesday, details a planned compliance review of the requirement that Medicare beneficiaries spend at least three days as a hospital inpatient before becoming eligible for skilled nursing services. Previous reviews found many Medicare payments for skilled nursing care were not compliant with the three-day rule, the OIG said. A report on the three-day qualifying rule is expected to be issued in FY 2016.

The OIG report also includes plans to review medical records for nursing home residents who were hospitalized for urinary tract infections. The review will help determine if the facilities provided services to prevent or detect UTIs in accordance with resident care plans. The results of that review are expected to be released soon the OIG said.

The office also will delve into the rates of and reasons behind Medicaid beneficiaries' transfers from nursing facilities to hospital emergency departments, with a report planned for FY 2017.

A review of the National Background Check Program for Long-Term Care Employees will continue through the current fiscal year, the report said, to determine the program's outcomes and whether it led to any “unintended consequences.” The review's findings will be released when the program concludes, in FY 2019 or later.

The office will also be increasing scrutiny of state survey agencies to determine whether they probably verified correction plans for nursing home deficiencies. The review was spurred in part, OIG said, by previous findings that one state survey agency did not always verify that facilities had corrected deficiencies found during surveys. That report also is expected next year.

Click here to read the OIG's full FY 2016 Mid-Year Work Plan.