State News for December 2016

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Reznik: Private industry luring away health quality agency employees.
Reznik: Private industry luring away health quality agency employees.


Healthcare regulatory vacancies are cause for alarm, state agency agrees, blaming increased workloads

MARYLAND — Vacancy levels nearly doubled at the state's top healthcare regulatory agency in 2015, shedding light on a staffing drain that goes far beyond Maryland's long-term care facilities. If left unresolved, more facilities could suffer quality of care problems, resident advocates said.

In its own budget report released earlier this year, the Office of Health Care Quality agreed that little is being done to reverse the problem.

The OHCQ said its staff turnover rate of nearly 8% is effectively hindering its ability to inspect long-term care facilities and follow up on care complaints. Response times, in fact, are more than three times longer than federal recommendations. About 20% of the agency's positions remain unfilled over the past year, according to one analysis.

A state legislative analysis found that chronic staffing shortages have plagued the OHCQ for several years, blaming the problem on factors that include mounting workloads, surveyor vacancies and a “structural deficiency in positions allotted for survey and inspection activities.” 

Rep. Kirill Reznik (D-Montgomery) who chairs the state health and human resources subcommittee that oversees the agency, told Capital News Service the agency is “losing people to the private sector, companies that the office is supposed to inspect.”

Facilities fight ‘clawbacks'

RHODE ISLAND — More than a dozen nursing homes say the state's Medicaid department has illegally attempted to recover millions of dollars it overpaid several years ago, claiming the agency is violating due process because it provided no notice of its intent to have the funds returned.

In their lawsuit filed in federal court in late October, the 17 facilities also have asked the court to approve the overpayments and stop collection efforts, claiming current federal law prohibits such efforts except under certain circumstances.

The overpayments occurred over a seven-month period beginning in October 2012 and were at rates never approved by the Centers for Medicare & Medicaid Services, according to published reports. In their 13-page complaint, the facilities also claim the state's Health and Human Services department violated the Medicaid and Americans with Disabilities acts. The complaint alleges that the state's so-called “clawback initiative” unduly shifts responsibility from the state agency to the facilities, according to the Rhode Island Courthouse News Service.


OIG: Corrections not verified

ARIZONA — The Department of Health and Human Services' inspector general claims the licensing division of the state's top health agency failed to follow up on more than half of deficiency corrections reported following 2014 surveys.

In its 20-page report, the federal agency found the state failed to verify corrections in 361 of the 650 deficiencies identified during surveys that year, recommending the agency improve its practices by obtaining evidence such corrections were made. Most of the failed verifications involved minor deficiencies, the report noted, adding “the state agency's practice for less serious deficiencies was to accept the nursing homes' correction plans as confirmation of substantial compliance without obtaining the required evidence of correction.”

State survey agencies must verify the correction of identified deficiencies by obtaining evidence of correction or through onsite reviews, according to the OIG. 


Workplace measure lauded

CALIFORNIA — The state is getting tough on workplace violence, and advocates for California's 100,000 registered nurses are applauding what could be the nation's most comprehensive effort to improve safety at healthcare facilities. 

In late October, the California Occupational Safety and Health Standards Board unanimously approved regulations to prevent workplace violence in healthcare settings. The regulations were provided for in a 2014 law, SB 1299, sponsored by the California Nurses Association/National Nurses United (CNA/NNU).

The regulations incorporate broad definitions of workplace violence to include not only acts of violence, but also the threat of violence. The law also emphasizes prevention over criminalization, and will require facilities to develop comprehensive workplace violence prevention plans.

Nursing advocates claim their profession faces high and ever-increasing rates of workplace violence. In 2014 alone, more than half of all such incidents occurred against workers in the healthcare and social assistance industry, according to National Nurses United, which has petitioned OSHA for a formal workplace violence prevention standard.

Medicaid dispute settled

ALASKA — The state has agreed to settle a dispute with its Medicaid claims processor after a series of problems involving provider reimbursements it says were delayed or inaccurate.

In 2014, the Department of Health and Social Services (DHSS) filed a complaint seeking nearly $47 million in damages from Xerox State Healthcare LLC a year after the company was contracted to process Medicaid claims. At the time, the state's health commissioner reportedly called the payment system his “greatest challenge in over 40 years of working in healthcare,” Alaska Dispatch News reported.

Under the settlement, Xerox will meet certain performance standards under a plan to implement hardware system upgrades and an accurate, efficient system to process claims. The state also will pay the company $26 million for services rendered. DHSS spokesperson Sarana Schell told the newspaper the state has paid Xerox about $112 million for the design, development, implementation and operation of the Medicaid payment system.

Xerox said it has implemented and received federal certification in 32 state Medicaid programs.


Aides trained in dental care

IOWA — Nurse aides are beneficiaries of a new state program designed to address one of the most overlooked areas of elder treatment in nursing homes – dental care.

Under a two-year, $150,000 grant to Iowa Caregivers by nonprofit insurer Delta Dental of Iowa Foundation, aides will receive basic training in preventative dental care for seniors. Iowa Caregivers Director Di Findley told NPR affiliate WVIK she believes dental assessments should be added during the intake process, especially for those receiving home healthcare services.

The grant extends a statewide effort to integrate oral health into standard care for seniors and those with disabilities.
Findley told NPR more than 100 aides so far have been trained through a program developed by Lifelong Smiles Coalition called Mouth Care Matters.


Advocates, industry at odds

ARKANSAS — Patient advocates and the nursing home industry were butting heads at press time over a plan that would have restricted the ability of residents and families to sue facilities for neglectful care. 

Near press time, the state Supreme Court invalidated a constitutional amendment measure the nursing home industry had earlier successfully placed on the Nov. 8 election ballot. The measure would have capped collectible damages at $250,000.

The tort reform effort has been mired in controversy. Some parties complained that facilities across the state were soliciting signatures from nursing home residents on petitions attesting their support for tort reform. ArkansasMatters, run by TV stations KARK 4 and KARZ 42, noted that it found about 20 nursing homes where the administrators or employees collected more than 100 signatures from nursing home residents. According to the Arkansas Times, a retired judge appointed by the Arkansas Supreme Court to review evidence in a challenge to the amendment uncovered some irregularities in the signatures.