The Centers for Medicare & Medicaid Services is putting more pressure on state survey agencies to “identify appropriate deficiencies” and perform other tasks triggered by routine annual surveys.

But a new scoring element for those agencies should not be seen as an attempt to create a deficiency quota, federal leaders told state agency directors this week.

The fiscal year 2025 state performance standards system guidance, used to measure how successful inspectors are in inspecting state and federally regulated nursing homes, was issued Tuesday but took effect Oct. 1.

It sets a series of goals that state agencies can meet, fail to meet, or partially meet, starting with a change in 2023 designed to recognize groups that make progress on a goal from year to year. Small, routine annual changes are normal.

For 2025, the agency added just one new measure: State agencies will be evaluated on six items that, when combined, show how well agencies perform on the Nursing Home Recertification Survey, citation of deficiencies and investigated tasks.

The six measures that make up the overall score are:

• Number of deficiencies per 1,000 beds

• Percentage of surveys without deficiencies

• Percentage of surveys identifying G, H, or I range and severity

• Percentage of surveys identifying J, K, or L range and severity

• Percentage of investigations where one or more mandatory tasks were not investigated

• Percentage of surveys where one or more triggered tasks were not investigated

Mandatory tasks include reviews of specific areas or programs, such as meals, medication administration, or quality and performance improvement. Triggered tasks occur if an inspector has a concern while on site, such as the physical environment, use of personal funds, or discrepancies in resident assessments.

CMS on defense

Even before the news of the new measure, CMS seemed to anticipate that the effort could make it appear that federal regulators are seeking more findings against nursing homes. The added pressure on inspectors comes months after the government gave itself the ability to fine suppliers both by the day and by court.

“This composite measure seeks to assess the performance of the State Study Agency, but is not an attempt to establish deficiencies or investigative quotas,” CMS said in Wednesday notewhich was signed by David Wright, CMS director of the Quality, Safety and Oversight Group, and colleague Karen L. Tritz, director of the Surveys and Operations Group.

“CMS seeks to understand the broader performance of the State Study Agency and not impose quotas or limits,” they added. “Furthermore, lower scores on this composite measure would not necessarily indicate that a state investigative agency is experiencing challenges in its work because the measure itself lacks context.”

However, by their own standards, CMS seems to be looking for a base score.

The new measure comes with a new type of “requires research” score. This designation forces a low-scoring state to “review the data and explore with CMS the potential underlying reasons for a lower composite score and, if necessary, strategies to improve its performance on these measures in the future.”

A state agency achieving a composite score of less than 120 points (out of a possible 150) will be in the “needs research” category, while an agency achieving a score of 120 points or more will receive an N /A and will not be obliged to perform further. evaluation. No met, not met, or partially met scores will be awarded, at least not in the first year of the measure.

CMS said it designed the new measure to “assess the frequency and type of nursing home deficiencies and performance of mandated or triggered tasks in health recertification surveys.”

“CMS is committed to working with state survey agencies to ensure that nursing home health recertification surveys are of high quality and identify appropriate deficiencies that reflect the quality of nursing home care and that inspectors report deficiencies at the appropriate level of scope and severity and complete mandatory or triggered survey tasks during nursing home surveys,” the memo said.

Spencer Blackman, director of product for post-acute analysis software provider StarPro, said CMS appears to be pushing surveyors further toward a national standard.

“The wording of the new measure appears soft and the boundaries of the six components are broad, but the message is clear: to fall in line with national expectations in terms of the number and scope/severity of deficiencies cited,” he said. McKnight Long Term Care News Thursday. “I’m not surprised. The survey remains the only element of the Five Star program that is state-specific, and there is still shockingly large variation in aggregate survey scores between states.”

He said the impact on facilities might not be immediate, but rather could be felt as a trickle-down effect that sees “the strict states loosening up and the label-happy ones reigning in a bit”.

He noted that differences in inspectors’ use of higher severity labels skewed how difficult it is to earn a high star rating in difficult survey environments such as New Hampshire, Rhode Island and Tennessee.

“The bottom line is that CMS is holding SNFs accountable for their performance, and in order to do that, CMS must hold their enforcement agencies accountable,” added StarPro Founder and CEO Colleen Muncy.

Other changes

Additional differences in the 63 pages of guidance were minimal.

CMS said it is withdrawing two measures from the previous fiscal year, a data submission measure and measures regarding the timeliness of recertification survey uploads, because the new iQIES reporting system “will allow for seamless survey uploads.”

The agency also reintroduced an updated version of the measure Assessing Deficiency Identification Using Federal Benchmark Surveys, essentially comparing how a state agency inspects a facility versus how a team member from a CMS office does it.

Despite provider concerns about delayed survey times and outdated data being reported on the Five-Star website, CMS has not made a major move to bring state inspectors back into compliance in a timely manner.

A report this summer By 2023, inspector performance found that only 20 states had reduced their recertification survey backlog by at least 50 percent, but persistent problems remained with untimely follow-up investigations.

CMS said it will continue to give state agencies leeway in catching up on recertification surveys in fiscal year 2025 in light of ongoing COVID backlogs.

Agencies must conduct a recertification every 15.9 months, and the statewide average between consecutive recertifications must be 12.9 months or less. CMS said it will not evaluate statewide average times this fiscal year.