September 27, 2022

Nursing home surveyors will begin using payroll data to investigate noncompliance with staffing rules, the Centers for Medicare and Medicaid Services announced in guidance issued Wednesday.

The agency also states that long-term care facilities must employ at least a part-time infection prevention employee, elaborates on new arbitration requirements and more. The guidance takes effect Oct. 24.

The document is part of President Joe Biden’s crackdown on nursing home safety and quality. The COVID-19 pandemic has disproportionately affected nursing home residents and employees: More than 155,000 have from the virus since the start of the pandemic, according to CMS data.

“CMS believes all people deserve to have access to quality healthcare and will continue working to improve the safety and quality of nursing home care,” a CMS news release says. “CMS will hold nursing homes accountable and make the quality of care and facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care.”

Biden has repeatedly called for updated staffing policies for nursing homes and directed CMS to set minimum requirements in his State of the Union address this year. The agency asked for feedback on how to design such requirements in a proposed rule published in April. The industry objects to staffing minimums.

The new guidance takes more immediate action by incorporating payroll data to guide nursing home investigations. Surveyors must ensure facilities comply with CMS requirements to have a registered nurse on duty for at least eight hours a day and licensed nurses on site at all times.

CMS also provides guidance on a rule that nursing homes have trained infection prevention specialists physically on duty, at least part-time. CMS and the CDC offer a free online course, and others may be available from states, associations or universities, the document says.

CMS clarifies that some inaccurate diagnoses of schizophrenia are related to unnecessary antipsychotic drug prescribing. Nursing homes are subject to a quality measure that tracks antipsychotic drug use, but patients with schizophrenia are excluded from the count. That means inaccurate schizophrenia diagnoses can artificially boost nursing home quality scores, according to CMS. Nearly one-third of residents with schizophrenia didn’t have any Medicare claims for the illness, Health and Human Services Department inspectors reported last year.

In cases of incorrect schizophrenia diagnoses, surveyors should determine if nursing homes completed accurate assessments, and possibly refer them to state medical or nursing boards, according to CMS.

The revised guidance also clarifies requirements for nursing homes entering into binding arbitration agreements with residents; CMS finalized the new requirements in 2019. Facilities cannot require such agreements as a condition of admission or care, and residents must have 30 days to rescind them, the guidance says. Nursing homes may not use these contracts to prohibit or discourage residents or any other party from communicating with federal, state or local officials, CMS wrote.

The agency also urges providers to provide more double- and single-occupancy rooms. Facilities newly certified or redone before Nov. 28, 2016, can allow for up to four residents per room, and facilities certified after that date can have a maximum of two residents to a room.

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