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Four Democratic senators are asking the Centers for Medicare & Medicaid Services to explain how its new risk-based nursing-home inspection process protects residents, while the agency says shorter surveys at qualifying facilities allow inspectors to spend more time on higher-risk homes and complaints.
Senators Elizabeth Warren of Massachusetts, Mazie Hirono of Hawaii, Kirsten Gillibrand of New York and Richard Blumenthal of Connecticut released their concerns in an October 27 announcement. Their letter, dated October 26, asks CMS Administrator Mehmet Oz to answer questions by November 9.
The dispute concerns the Risk-Based Survey program, which CMS began implementing nationwide on September 8. It changes the scope and staffing of standard recertification surveys for nursing homes meeting specified performance criteria. It does not remove all inspections from those facilities.
What the senators are questioning
The senators argue that the shorter process could miss deficiencies and that past quality ratings may not reliably predict a home’s future performance. They cite a review by the National Consumer Voice for Quality Long-Term Care identifying nearly 1,700 eligible homes with an estimated 114,300 residents.
The resident figure is an estimate of the population in eligible homes cited by the senators, not a count of residents shown to have been harmed by the new survey process.
The letter also cites Consumer Voice findings about historical abuse indicators, payment denials and changes in facilities’ eligibility. Those findings are presented as the senators’ grounds for requesting information, not as a new CMS determination that every home on the list is unsafe.
The senators ask CMS to provide evidence supporting its qualifying criteria, explain how it monitors missed or delayed findings of harm, and identify conditions that would cause the agency to change or suspend the program. They also seek comparative reporting on complaints, hospitalizations and deficiencies, and ask for the legal basis for the survey protocol.
CMS says the goal is to redirect limited inspection resources
In its September 29 implementation memorandum, CMS says federal funding for nursing-home surveys has not increased since 2015 while state survey agencies’ obligation to conduct complaint surveys has risen by more than 20%.
The agency says those pressures have contributed to inspection backlogs and difficulty investigating complaints where residents may face harm. Its stated goal is to direct more resources to higher-risk settings while using a more focused process at qualifying homes.
CMS says it tested the approach in 22 states and more than 100 facilities and found results comparable to the traditional survey process. The agency describes the risk-based survey as taking roughly half the time with fewer surveyors and a smaller sample of residents, while retaining a review of required areas.
Those are the agency’s findings and rationale in its existing memorandum, not a new response to the senators’ letter.
Eligibility is conditional
The CMS criteria include a five-star overall rating, at least a three-star staffing rating and no actual-harm, immediate-jeopardy or substandard-quality citations in the last survey cycle. Other conditions concern audits, ownership changes, survey history and additional quality indicators.
The memorandum also lists events that disqualify an otherwise eligible home before a risk-based survey begins. These include certain new citations, pending immediate-jeopardy investigations, more than three qualifying pending non-immediate-jeopardy complaints or facility-reported incidents, nursing waivers and ownership changes. If an exclusion applies, the state must use the standard survey process.
States may also choose the traditional survey at a qualifying facility because of safety concerns, and CMS may require it. For operators and administrators, eligibility is therefore not a permanent exemption. For residents and families, the senators’ request focuses on whether those safeguards and the shorter survey process will identify problems reliably.
JBizNews Desk | Washington
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