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More oversight is coming for nursing home providers after the Centers for Medicare & Medicaid Services directed surveyors to take a more critical look at nurse competency and residents’ quality of care under a new memo issued Friday. 

The increased scrutiny calls on surveyors to place more focus on residents’ quality of life and associated concerns in response to concerns that CMS and surveyor agencies haven’t been able to have the traditional level of visibility in facilities to assess quality of care and compliance during the pandemic. 

Surveyors are being directed to place special attention on things such as nurse staff abilities and actions, use of antipsychotics and areas of care where residents’ health and safety may be at an increased risk. That means having a more critical eye on unplanned weight loss, loss of function/mobility, depression, abuse/neglect or pressure ulcers. 

Reducing backlogs

Friday’s memo also laid out several steps for investigators to address the backlog of complaint and recertification surveys, which includes revising the criterion for COVID-19 Focused Infection Control (FIC) surveys and guidance for resuming recertification surveys.

CMS is no longer requiring that FIC surveys be conducted within three to five days of a nursing home having three or more new COVID-19 confirmed cases, or one confirmed resident case in a facility that was previously COVID-free. Surveyors, however, must still perform annual FIC surveys of 20% of nursing homes and states are being directed to prioritize these surveys for facilities that are reporting new cases and have low vaccination rates. 

“To count toward the required 20%, these FIC surveys must be stand-alone surveys not associated with a recertification survey; the FIC survey may be combined with a complaint survey,” the memo states. 

States that fail to perform these survey activities “timely and completely” could forfeit up to 5% of their Coronavirus Aid, Relief, and Economic Security (CARES) Act allocation, annually, CMS said.

Resuming recertification surveys 

Surveyors were also directed to resume recertification surveys on a regular basis, and to do so by establishing new intervals based on each facility’s next survey rather — and not the last one that was conducted prior to the COVID-19 pandemic. 

CMS added that agencies should prioritize recertification surveys according to the potential risk of residents, and provided guidance on how surveyors can investigate the backlog of complaints/facility-reported incidents based on the level of triage.  

“CMS acknowledges that conducting multiple complaint and FRI investigations on standard recertification surveys will likely result in extending the length of time to conduct the surveys,” the agency said. “In light of these challenges, CMS will work with SAs to establish reasonable expectations for when these requirements should be met based on the size of the backlog and each SA’s plan to address it.”