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State Attorneys General are successfully litigating issues of key importance to nursing home residents, including insufficient nurse staffing levels and inappropriate transfers or discharges of residents. This Alert discusses two cases: the Pennsylvania Attorney General’s challenge to inadequate staffing levels by a national chain and the Maryland Attorney General’s challenge to a state chain’s transfer … Read more

Under the Trump Administration, the Centers for Medicare & Medicaid Services (CMS) has been advancing “burden” reduction measures in nursing homes. The focus of these measures is to reduce both minimum safety standards for resident care and financial penalties when those minimum standards are violated. This rollback builds on the long and, too often, significant … Read more

On September 20, 2018, CMS issued a notice of proposed rulemaking (NPRM) to revise the emergency preparedness program requirements. Most notably, the proposed rule would allow nursing homes to review their emergency preparedness programs and to train staff to carry out those plans every two years rather than annually. The HHS Office of the Inspector … Read more

On October 11, 2018, the Department of Health and Human Services published final rules updating civil money penalty (CMP) amounts for civil penalties assessed on or after October 11, 2018 for violations of various HHS programs occurring on or after November 2, 2015.  83 Fed. Reg. 51369 (Oct. 11, 2018) (“Annual Civil Monetary Penalties Inflation … Read more

             According to the Centers for Medicare & Medicaid Services (CMS), more than 95 percent of nursing home deficiencies are cited as “no harm.” In other words, less than five percent of all nursing home violations of health, safety, and resident rights standards are identified as causing any resident harm … Read more

The involuntary transfer and discharge of nursing home residents is the top complaint received by nursing home ombudsman programs nationwide.  In December 2017, the Centers for Medicare & Medicaid Services (CMS) announced an initiative “to examine and mitigate facility-initiated discharges that violate federal regulations.”[1]  While recognizing the seriousness of involuntary transfer and discharge for residents … Read more

For the first time in many years, Congress held a hearing on nursing home quality of care on September 6, 2018.  The hearing of the Subcommittee on Oversight and Investigations of the House Energy and Commerce Committee, entitled “Examining Federal Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes,” featured three witnesses: … Read more

Examining Federal Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes House Committee on Energy and Commerce Subcommittee on Oversight and Investigations Hearing September 6, 2018 Statement of the Center for Medicare Advocacy The Center for Medicare Advocacy thanks the Committee for holding this important hearing on nursing home quality.  Both the Government … Read more

Elder Justice: What "No Harm" Really Means for Residents is a monthly newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a "no harm” deficiency is and what it means to nursing … Read more

A joint Statement from the Center for Medicare Advocacy and the Long Term Care Community Coalition Background. Substandard care and insufficient staffing are longstanding problems in too many nursing homes across the United States. The nursing home industry often blames lack of funds for the failure to ensure appropriate staffing. However, the nonpartisan Medicare Payment Advisory … Read more

The Center for Medicare Advocacy issues this Special Report to shine a light on nursing homes throughout the country that have been identified as providing the poorest quality care to residents – while facing limited, if any, enforcement action as a consequence. Known as Special Focus Facilities, (SFFs), these facilities are identified by the Centers … Read more

Seema Verma, the Administrator of the Centers for Medicare & Medicaid Services (CMS), invited the Center for Medicare Advocacy and other advocacy organizations to meet with her on June 25, 2018. The Administrator asked our organizations to provide one to two recommendations for the Requirements of Participation that would reduce burdens on nursing facilities. However, … Read more

The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification Letter on October 27, 2017, which outlined proposed changes to Chapter 7 of the State Operations Manual (SOM), and invited public comment. As the Center for Medicare Advocacy noted in a previous alert, the proposed changes sought to reverse surveyor guidance issued … Read more

Since January 2017 the health and safety of nursing home residents has become increasingly imperiled. Nursing home lobbyists have urged the Centers for Medicare & Medicaid Services (CMS) to eliminate or delay regulations and dramatically reduce enforcement of violations. Unfortunately, CMS has shown a disturbing willingness to follow these lobbyists’ recommendations. For example, under regulations … Read more

On June 4, 2018, the House of Representatives Democratic Caucus Seniors Task Force held a briefing on “Protecting Seniors by Improving – Not Eroding – Nursing Home Quality Standards.” The Center for Medicare Advocacy, led by Senior Policy Attorney Toby Edelman, presented on the enforcement of the nursing home standards, as well as the current … Read more

In their April 2, 2018 letter to CMS Administrator Seema, Republican leaders of the House Energy and Commerce Committee express serious concern about “recent media reports describing horrific instances of abuse, neglect, and patient harm allegedly occurring at SNFs and NFs across the country.”[1]  They focus particular attention on Dr. Jack Michel, an owner of … Read more

A February 5, 2018 report from the Government Accountability Office (GAO) revealed that thousands of "Critical Incidents" in assisted living facilities occur regularly with little accountability, highlighting the need for federal protections for assisted living residents.  The Long Term Care Community Coalition and the Center for Medicare Advocacy released a joint statement calling for immediate action … Read more

Elder Justice: What "No Harm" Really Means for Residents is a monthly newsletter published by the Center for Medicare Advocacy and the Long Term Care Community Coalition. The purpose of the newsletter is to provide residents, families, friends, and advocates information on what exactly a "no harm” deficiency is, how prevalent "no harm" deficiencies are, … Read more

A lawsuit by former residents at 12 Arkansas nursing facilities owned by Golden Living alleged that the facilities were chronically understaffed between December 2006 and July 2009, in violation of the facilities’ admission agreement, the Arkansas Long-Term Care Residents’ Rights Act, and the Arkansas Deceptive Trade Practices Act.[1]  The case was settled in 2017 for … Read more

In October 2017, CMS announced its new “Patients over Paperwork” initiative.[1] The objective of the initiative is to adhere to the Trump Administration’s Executive Order (EO 13771), which tasked agencies with cutting regulations.[2] Specifically, the purported intent of the initiative is to put patients first by reducing the so-called “burdens” on the health care industry. … Read more

Are Nursing Home Residents at Risk? New York Times and Los Angeles Times Report on SNF Deregulation Special Issue Alert: Enforcement in Kansas Are Nursing Home Residents at Risk? The New York Times and Los Angeles Times Report on SNF Deregulation Don't Miss It! 5th Annual National Voices of Medicare Summit & Sen. Jay Rockefeller … Read more

In October of 2016, the Obama Administration issued a Final Rule regarding the Requirements of Participation (RoP) for nursing homes. The Final Rule was issued, in part, because the regulations had “not been comprehensively reviewed and updated since 1991.”[1] Under the Final Rule, the revisions to the RoP were to be implemented over three phases: … Read more

Reports indicate that state surveyors cite nursing home deficiencies at a “no harm” scope and severity level 95 percent of the time. Unfortunately, this has a profound impact on a nursing home resident’s quality of care and quality of life. CMS data provide clear evidence that residents are actually being harmed by such deficiencies, despite the … Read more

November 22, 2017 Division of Nursing Homes Survey and Certification Group Center for Medicare & Medicaid Services 7500 Security Blvd. Baltimore, MD 21244 Re: Revised Policies regarding the Immediate Imposition of Federal Remedies-FOR ACTION (S&C: 18-01-NH) Submitted electronically: dnh_triageteam@cms.hhs.gov. Dear David, Karen, Evan, Lisa, and CMS colleagues,    The Center for Medicare Advocacy (Center) is … Read more

Tax Cut Bill Just Got Worse. Health Care at Risk. This Week in Sabotage CMS Steering to Medicare Advantage Administration And Nursing Home Industry: Lockstep in Deregulating Nursing Facilities & Reducing Resident Protections Tax Cut Bill Just Got Worse.  Health Care at Risk. Free Webinar Series Next Webinar: Hospital Observation Status Update January 24, 2018 … Read more

The U.S. Senate Special Committee on Aging held a hearing on "Disaster Preparedness and Response: The Special Needs of Older Americans" today. The hearing came on the heels of Hurricanes Harvey and Irma, which resulted in the deaths of at least nine nursing home residents in Florida. Chairman Collins began the hearing by acknowledging the … Read more

Under the federal Nursing Home Reform Law, the Centers for Medicare & Medicaid Services (CMS) has authority and the “responsibility”[1] to impose Civil Money Penalties (CMPs) and other enforcement actions at nursing homes that are found to violate federal standards of care (which are called Requirements of Participation).[2]  For the first time in more than … Read more

For the first time in 20 years, there will be an increase in the amounts of federal fines that nursing facilities may be required to pay for violating the Nursing Home Reform Law.  A little-noticed provision of the Bipartisan Budget Act of 2015, Pub.L. 114-74 (signed by President Obama on November 2, 2015), amends the … Read more

Civil Money Penalties for nursing facilities have historically been too low to provide meaningful incentive for most facilities to comply with federal standards of care implemented to ensure patient safety and well-being.  The new Civil Money Penalty Analytic Tool from the Centers for Medicare & Medicaid Services (CMS) does not solve this problem. Background Every … Read more

Inadequate nurse staffing is the most significant predictor of poor care in nursing facilities.  Despite the fact that understaffing is a pervasive and nationwide problem,[1] understaffing is rarely cited by state survey agencies.[2]  One reason for the lack of deficiencies and enforcement actions is that the federal standard for nurse staffing is vague.  Aside from … Read more

The federal nursing home website, Nursing Home Compare, is about to undergo major changes that should significantly improve the accuracy of information about nursing homes that is provided to the public.  The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act of 2014), signed by President Obama on October 6, 2014, supports one of … Read more

June 12, 2014 Quality Assessment and Performance Improvement (QAPI) In Nursing Homes: Diverting CMS Attention from Enforcement In the past few years, the Centers for Medicare & Medicaid Services (CMS) has focused considerable attention on Quality Assessment and Performance Improvement (QAPI) in nursing homes.  This focus, we fear, is diverting the agency's resources from enforcing … Read more

The Department of Health and Human Services' Inspector General recently reported that nearly one third-of nursing home residents suffered an adverse event or other harm during a stay in a Medicare-participating nursing home in August 2011, and that most of the adverse events or other harm were preventable and the result of problems in staffing.[1] … Read more

In its first analysis of adverse events in skilled nursing facilities (SNFs), the Department of Health and Human Services' Office of Inspector General (OIG) reports that care is poor and dangerous for many residents.  OIG reports that nearly one in three Medicare beneficiaries who went to SNFs for 35 days or fewer in August 2011 … Read more