The Centers for Medicare & Medicaid Services has for the first time revealed key facts about the shorter survey option for select, “higher-quality” nursing homes, including how many state survey agencies could be involved and the evolving nature of the program.

The risk-based surveys were officially launched this spring and touted as a way CMS can help state survey agencies catch up on routine recertifications as a result of extended delays in the COVID era. But officials kept details about the process — and which facilities are eligible — close to the vest.

In a letter responding to concerns from the Center for Medicare Advocacy and others, Dora L. Hughes, MD, CMS Chief Medical Officer and acting director of the Center for Clinical Standards and Quality, revealed that providers in at least 20 states will be involved in the testing period.

“Our primary goal is to test the RBS in as many states as necessary to ensure that the survey is being tested in facilities and among inspectors that are broadly representative of facilities and inspectors across the country,” Hughes wrote in an Oct. 17 letter , distributed by CMA. Thursday.

“States will be selected in collaboration with state agencies based on the availability of inspectors cross-referenced by nursing homes that qualify for an RBS,” she added.

That qualification threshold raised concerns among the Center for Medicare Advocacy, but also left nursing home operators unclear about whether they had done the work needed to qualify for a potentially shorter inspection.

In a short website announcement in AprilCMS said higher quality “could be indicated by a history of fewer citations for noncompliance, larger staffing, fewer hospitalizations, and other characteristics (eg, no citations related to resident injury or abuse, no pending investigation for residents in immediate danger of serious injury). , compliance with personnel and data transmission requirements).”

In May, the Center for Medicare Advocacy was one of 15 groups protests against the vague definition in a letter to CMS Administrator Chaquita Brooks-LaSure.

“The criteria are inappropriately limited: a history of fewer noncompliance citations is not a meaningful criterion when many facilities have not had a standard survey (recertification) in two to three years or more,” the CMA wrote at the time times.

The organization remained unmoved by Hughes’ letter, writing last week that the definition was “particularly weak” and again citing “decades of reports” from the General Accounting Office documenting the undercoding of deficiencies as less serious than those, 2 percent of quoted facilities. with immediate danger and vague “higher allocation” criterion.

While not sharing CMS’ specific criteria and acknowledging that the RBS process may differ from state to state, Hughes insisted that inspectors would have high expectations of any providers who opted into the program.

“Regardless of the RBS criteria or process, if there are resident care issues that are identified, inspectors will expand the survey and not leave the facility until all resident safety concerns are addressed,” she wrote. “The safety of residents will always be a priority, regardless of the type of survey process.”

Hughes also said that even in states testing the shorter surveys, states still have broader oversight in investigating complaints where the allegation of noncompliance could put residents in immediate danger of serious harm.

CMS said it will continue to refine the risk-based survey and its effectiveness by comparing the results to the results of a full recertification survey; including additional inspectors at tests to investigate whether there were concerns that went uncaught; and conducting “comprehensive debriefing sessions” after each round of testing to obtain feedback for future potential changes.

Uncertainty continues

This latest survey process adds more uncertainty for providers, who have anecdotally reported that the length of traditional surveys has increased, even as many states still fail to review every facility annually as required by the federal government.

“With the survey and certification system, we know there are a lot of inconsistencies,” said Janine Finck-Boyle, LeadingAge’s vice president for health policy, who described the current CMS effort as “beta testing.”

“Instead of this normal survey process that you have with all the particular tasks and requirements, it would be a shorter time and fewer actual requirements,” she told attendees of a federal policy discussion at the annual LeadingAge meeting in Sunday.

Given new, expanded civil monetary penalties; survey late in most states; and other concerns about how inspectors interact with nursing homes, LeadingAge is conducting a project to identify variations in state interpretations of CMS rules.

“While CMS is doing the risk-based survey and they’re doing their job, we’re looking at the inconsistencies in the survey process itself: the good, the bad and the ugly, and trying to bring that to CMS as we are. advocating to make some changes,” Finck-Boyle said.

In addition to the risk-based approach, CMS announced last week that it is adopting a a new performance metric for routine recertification inspectors. The composite score includes target scores for the number of deficiencies per 1,000 beds; the percentage of investigations without deficiencies; the percentage of surveys identifying the scope and severity of G, H or I; and the percentage of surveys identifying J, K, or L range and severity.

Some see it as pressure on state agencies to move to a national standard for citations.