CMS clarifies long-term care quality review in managed care models

The Government Accountability Office alleges that the Centers for Medicare & Medicaid Services has yet to enforce several of its recommendations after a GAO report found oversight gaps in abuse reporting requirements for nursing homes.

The GAO made the proclamation Thursday in a follow-up report. Its original report, which was released earlier this year, found that abuse deficiencies cited in nursing homes more than doubled from 2013 to 2018. 

It also determined that information on abuse and perpetrator types were not readily available, facility-reported incidents lacked key information, and gaps in the CMS process for state survey agency referrals to law enforcement. 

The GAO recommended in the first report that CMS require state survey agencies to submit data on abuse and perpetrator type and develop guidance on what abuse information nursing homes should self-report. 

It also made several recommendations on timely referring abuse to and sharing information with law enforcement, substantiating allegations and tracking referrals. The Department of Health and Human Services (HHS) agreed with each of those recommendations. 

HHS, which houses CMS, has yet to implement any of those guidelines as of November, the GAO now argues.

“It is imperative that CMS have more complete and readily available information on abuse to improve its oversight of nursing homes. It is also essential that CMS require state survey agencies to immediately report incidents to law enforcement if they have a reasonable suspicion that a crime against a resident has occurred in order to ensure a prompt investigation of these incidents,” the report stated.