CMS Issues Memo on Sequestration Adjustments for Survey & Certification

The Centers for Medicare & Medicaid (CMS) has issued a memo to State Survey Agencies regarding adjustments in long term care surveys to accommodate sequestration due to overall S&C Medicare budget reductions.  CMS advises that States must adhere closely to CMS priorities in conducting all future survey and certification work.  Of particular importance to our members is the guidance on changes related to onsite revisit surveys conducted to confirm that a provider has remedied all health and safety noncompliance and restored its program to compliance with CMS requirements.  

In order to conduct revisits:

  • The State Agency (OLC) must obtain CMS Regional Office approval before conducting any second onsite revisit after a first revisit identified that the provider had not achieved substantial compliance,
  • OLC must obtain CMS Central Office approval before conducting a third or fourth onsite revisit (in cases where a third or fourth revisit is permitted by CMS policy) when the prior revisit found that the provider had not restored its program to substantial compliance.

OLC has been instructed to inform affected providers that there may be longer wait times before revisits are conducted.  Existing protocols already require consultation and approval from CMS for some revisits, e.g., third and fourth revisits.

A second item in the Memo relates to Special Focus Facilities (SFFs), those nursing facilities that have exhibited a persistent pattern of poor quality and have been enrolled in the Special Focus Facility initiative.  Moving forward OLC must take the following actions:

  • Schedule a final “last chance” onsite survey for facilities that have been on the SFF list for more than 18 months and have failed to improve.  The scheduling of the survey may coincide with the next planned onsite survey, or be advanced in accordance the extent to which State monitoring continues to indicate lack of significant progress.  A Medicare termination notice may be issued if the onsite survey does not reveal appropriate improvement or unless there is a major new development that CMS concludes is very likely to eventuate in timely and enduring improvement in the quality of care or safety.
  • Review the progress of all other facilities that have been on the SFF list for more than 12 months.  CMS staff, in consultation with OLC, will discuss the status of each facility and plan further action.
  • Until further notice State agencies will not select a replacement SFF nursing home when a current SFF facility has been terminated from Medicare participation or has improved to the point of graduating from the SFF list, unless directed to do so by the CMS Regional Office.

Life Safety Code (LSC) inspections in facilities are also addressed in the sequestration Memo.  CMS is making a Short Form LSC survey as a State option that surveyors may use to assess compliance with key life-safety code requirements for those nursing homes that CMS determines have a consistently good track record of LSC compliance in the past, provided the nursing home is also fully-sprinklered.  CMS will provide a list to each SA regarding the facilities that may qualify for the Short Form survey.  A separate S&C Memorandum (S&C 13-22-NH) offers specific details related to this option and the methods by which a State may do so.  We are currently communicating with the State Fire Marshal about implementing the short form in Virginia and will keep members informed about the outcome of our discussions.