A far-reaching plan that officials said would strengthen government rules for inspection of nearly 16,000 nursing homes with about 1 million patients has been drafted by the Health and Human Services Department and will be formally proposed this week.
The proposal, which will not be put into final form until the department has studied public comment, would apply to all nursing homes that care for any Medicare or Medicaid patients. The inspections, handled by state agencies under agreements with HHS, determine whether nursing homes are observing basic regulations on staffing, nutrition, quality of care and other nursing quality standards required by the government.
The new inspection rules, drafted by Medicare-Medicaid administrator William L. Roper, make a number of major changes based in whole or in part on recommendations of the Institute of Medicine (IOM). The institute was asked to study the issue after key congressional committees blocked an earlier set of HHS nursing-home regulations that the committees charged would weaken patient protections.
Roper called his proposal "another important step in improving the regulation of nursing homes; it builds on the recommendations of the IOM and emphasizes surprise in inspections, more strict rules of exclusion for those with repeated deficiencies" and tougher rules for a nursing home to get back into the program if ousted for deficiencies.
Julie Trochio, an official of the American Healthcare Association, an organization of about 9,000 nursing homes, both for-profit and nonprofit, said, "On the whole we agree with how they implemented the IOM recommendations," adding that they would strengthen quality of care.
But she said there were indications that some trivial violations might be classified as "immediate and serious threats" to patients' health, and sanctions would be invoked.
A congressional expert on nursing regulations, who asked not to be identified, said that while the regulations, as described by a reporter, appeared clearly "better than what we have now, they are not necessarily as strong" as a bill included by Rep. Henry A. Waxman (D-Calif.) in the House version of the budget reconciliation bill.
For example, she said, Waxman allows a maximum of 15 months between inspections while the regulations list 24 months as an option for homes with good records.
The new rules:
Would abandon the standard annual inspection, which, though theoretically given without advance notice, actually turned out to be "predictable," and allowed homes to clean up violations at the last minute merely to pass inspection. Instead, the proposal would call for more frequent inspections of homes with poor records and less frequent for those with good records, and emphasize the element of surprise.
The new regulations propose two inspection alternatives, one of which will be chosen after public comment.
The first, similar to an IOM recommendation, would require surprise inspections at least once every nine months for nursing homes with poor compliance histories, and at least every 15 months for those with good compliance histories.
The alternative would require surprise inspections at least every 24 months for homes with no history of deficiencies and at intervals ranging from six months to 18 months for others, depending on their records.
Would exclude a nursing home from the Medicaid and Medicare programs if it had deficiencies of the most serious type in two or three consecutive inspections, even if it corrected them after the inspection.
After correction, a waiting period for readmission of three months would apply where the original problems did not present an immediate and serious threat to health and safety, an exclusion of six months would apply if the problems did present an immediate and serious threat, and an exclusion of at least a year would apply if there was a record of repeated serious deficiencies.
Would combine rules for Medicaid and Medicare, reducing paperwork and red tape.