Archived Article: Washington Update - Inspector General Issues Flawed Report On Distinct Part Certification and Financial Screening (Copyright Center for Medicare Advocacy, Inc.)

INSPECTOR GENERAL ISSUES FLAWED REPORT
ON DISTINCT PART CERTIFICATION AND
FINANCIAL SCREENING IN NURSING HOMES

Seventy-eight percent of hospital discharge planners believe that placing Medicaid beneficiaries in nursing homes is Avery difficult@ or Asomewhat difficult.@ Seventy percent of discharge planners report that nursing homes refuse to admit residents because of financial reasons. Despite these reports from the front-line workers whose jobs involve finding nursing home beds for hospital patients, the Office of Inspector General (OIG) concludes in a recent report that distinct part certification does not limit Medicaid beneficiaries= access to facilities and that financial screening is not a widespread problem in the nursing home industry. Distinct part certification is certification of a portion, rather than all, of a facility=s beds that are eligible for certification; financial screening is defined as facilities= requesting financial information as part of the admissions process.

The OIG appears to have based its conclusions on the comments of others whom it interviewed, chiefly state Medicaid officials, 64 nursing home administrators, and the two national nursing home trade associations (the American health care Association and the American Association of Homes and Services for the Aging). Neither Medicaid officials nor industry representatives thought that requirements for full certification would affect the numbers of Medicaid beneficiaries admitted to facilities. No Medicaid officials reported that Medicaid beneficiaries are denied access to facilities Avery often@ because of financial screening and only two thought admission was denied Asomewhat often.@ The officials generally viewed financial screening as not affecting admission of beneficiaries. Provider representatives also denied that financial screening is a problem and two-thirds opposed any limits on their ability to engage in financial screening.

State long-term care ombudsmen, who were also surveyed by OIG, expressed more concerned with both distinct part certification and financial screening. Twenty-two ombudsmen reported that distinct part certification limits access for Medicaid beneficiaries; seven ombudsmen believed that distinct part certification affected access to a Alarge extent;@ 18 ombudsmen, to Asome extent.@ (Twenty-two states prohibit distinct part certification.) Eight ombudsmen believed financial screening affected access Avery often;@ 11 ombudsmen, Asomewhat often.@ OIG appears to have discounted the views of ombudsmen in its report.

The OIG report does not mention the HCFA Region V ruling (Sep. 1, 1992) that the practice of financial screening violates the anti-discrimination provisions of the 1987 nursing home reform law.

Although the respondents gave totally divergent views on the issues, the OIG report also fails to explain the differences by respondent category or the reasons why such divergent views might exist. For example, since 22 states prohibit distinct part certification, do the 22 ombudsmen who reported no problems with distinct part certification live in those 22 states? The GAO=s conclusions appear to reflect primarily the views of those who report no problems and therefore, no need for solutions.

Advocates for residents are troubled by the report, which may put an end to HCFA=s commitment to prohibit financial screening and to limit distinct part certification. See, e.g., HCFA=s Regulatory Agenda, 64 Fed. Reg. 21196 (Apr. 26, 1999), #1103, HCFA-3815-P.

The report, Office of Inspector General, Department of Health and Human Services, The Effect of Financial Screening and Distinct Part Rules on Access to Nursing Facilities, OEI-02-99-00340 (Jun. 2000) is available at http://www.hhs.gov/oig/oei/whatsnew.html.