The CMS’ Region VII office, and Midwest division leadership held a LTC Provider Association Meeting on December 14-15, 2017 in the Kansas City CMS office. Two representatives from each of the Region VII long term care provider associations were invited to attend. Debra Zehr and Rachel Monger attended on behalf of LeadingAge Kansas. The agenda was very controlled, as was discussion on many topics. However, we did pose as many questions as possible, and were able to glean quite a bit of information form the day and a half of meetings.
Topics covered in the meeting included Emergency Preparedness and Life Safety Code, CMP Enforcement, Region VII Survey Trends, and Involuntary Discharge. Below is a breakdown of notable information provided by the agency.
EMERGENCY PREPAREDNESS & LSC
CMS’ Katharine Achor presented on Life Safety Code trends new emergency preparedness requirements. Her presentation she highlighted what CMS has found to be missing in provider Emergency Preparedness plans thus far. This included:
- Missing policies and procedures based on the emergency plan and risk assessment;
- Missing policies and procedures addressing a range of issues including:
- Subsistence needs
- Tracking patients and staff
- Sewage
- Potable water needs (should include staff/volunteers); and
- Annual drill and tabletop
Ms. Achor also reported the most frequently cited K-tags nationally thus far in CY17:
- K353 – Sprinkler Maintenance
- K363 – Corridor Doors
- K321 – Hazardous Areas
- K372 – Smoke Partitions
- K920 – Power Strips
- K712 – Fire Drills
- K345 – Fire Alarm Maintenance
- K918 – Generator Maintenance
- K511 – Gas and Electrical Utilities
- K324 – Cooking Facilities
View Ms. Achor’s presentation slides for more info.
In addition to providing this list of frequently cited deficiencies, Ms. Achor included a separate document of how to avoid citations in these areas. View Ms. Achor’s tips and tricks.
Additional documents were distributed related to power strip Q&A and fired-up articles released to assist providers in understanding the LSC requirements. Please check them out.
CMP ENFORCEMENT
CMS’ Ruth Powers presented on recent changes related to CMP enforcement. She specifically discussed S & C Letter 18-01-NH which replaced the previous memo on immediate imposition of federal remedies. The new policy on CMP impositions reverses the previous order to automatically assess CMP no matter the circumstances surrounding the citation, and encourages more use of per instance penalties in cases of noncompliance that occurred in the past. Ms. Powers described the purpose behind these changes and what providers can expect to see happen:
- Improved consistency among all 10 Regions
- Allows more leniency to impose per instance CMPs
- By the end of FY 18, will see more of a balance of per instance CMPs and per diem CMPs
- A downshift of CMPs imposed in the region and more of a balance, and
- Looking at facilities closer and doing a financial hardship review when considering penalties
Ms. Powers indicated that these changes were being made to reduce the punitive nature of the enforcement system.
Association representatives pressed CMS officials on the connection between large penalties and improved care in nursing homes. LeadingAge Kansas and LeadingAge Iowa both encouraged CMS to explore systems based on collaborative relationships and deemed status. CMS indicated that they will follow-up on these questions.
Involuntary Discharge
On the first day of the LTC Provider Association Meeting, there was a presentation given titled, “Midwest DSC Involuntary Discharge Initiative”. The presentation outlined concerns from the Ombudsmen and the Surveyors, the lack of enforcement remedies being implemented, and recent media attention surrounding involuntary discharges from nursing homes. The Initiative has been underway since 2016.
Initiative requires the Region VII state agencies notify the regional office of any cases citing involuntary discharge tags at F622 – F626 at a Scope and Severity D or above. The regional office evaluates each case individually to determine the appropriateness of enforcement remedies, including CMPs and denial of payment for new admissions. During the presentation, it was reported the Midwest Division has imposed enforcement on 22 facilities thus far, and the CMS Central Office is reviewing the initiative on a national level and will decide on how the project will be carried out in the future.
Members can click here to view a 16-minute training video on Admission, Transfer, and Discharge Rights developed by CMS.
