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Ensuring nursing home quality remains one of the top 10 challenges facing the Department of Health and Human Services. That’s according to a newly issued list from HHS’ Office of Inspector General. After not appearing on the list in 2012, nursing home oversight was ranked the No. 7 priority in 2013 and now is No. 5.

The watchdog agency defines the challenge as “ensuring quality in nursing home, hospice, and home- and community-based care.” On last year’s list, hospice was not specifically named.

Nursing home and hospice oversight remains a top concern due to continued OIG findings of problems in these settings, the agency explains in its “top challenges” document. Frequent adverse events in skilled nursing facilities and inadequate monitoring of hospice surveys are cited as recent issues brought to light by OIG investigations.

Legislation passed over the last year has given federal overseers “new tools” for ensuring high-quality care in these settings, the OIG notes in the top challenges document. “The Department should use these tools to improve the care people receive in these settings,” the document states. In particular, the IMPACT Act mandated hospice surveys once every 36 months, and the Protecting Access to Medicare Act of 2014 creates payment incentives for high-performing nursing homes.

A number of the other top challenges also could suggest increased OIG oversight and enforcement actions against long-term care providers. These challenges include “fighting waste and fraud and promoting value in Medicare Parts A and B” and “the meaningful and secure exchange and use of electronic health information.”

Click here for the complete document, which was released Tuesday.