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 CMS Push for More Federal Funding for Survey Draws Industry Support

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma released a blog post this week offering more details on quality and safety measures for skilled nursing facilities (SNFs), including a request for additional federal money to bolster the survey process and State Survey Agencies (SSAs).

The post, titled, “Ensuring Safety and Quality in Nursing Homes: Five-Part Strategy Deep Dive,” picked up where CMS left off in April when Verma announced a five-part approach to the issue, which entails efforts to: Strengthen Oversight, Enhance Enforcement, Increase Transparency, Improve Quality, and Put Patients over Paperwork.

The new blog entry is the first in a series on each of the five categories and covered oversight matters.

After describing the steps CMS has taken to modernize and improve the survey process, Verma said the agency is not alone in this effort, and needed help from Congress, too.

Currently, she said CMS (through SSAs) is required by law to annually inspect each SNF that participates in Medicare and Medicaid, a total of approximately 15,000 facilities. Additionally, SSAs inspect SNFs upon receipt of complaints or facility-reported incidents. Combined, these surveys total roughly 70,000 inspections each year.

“This is a monumental task. The mandated annual survey cycle is costly to SSAs and requires us to use precious resources to survey each facility, regardless of their quality performance,” Verma said.

As a result, she said in President Trump’s Fiscal Year (FY) 2020 budget proposal, “we’ve asked Congress for the authority to transition to a risk-based survey model for nursing homes so we can target low-performing nursing homes with more frequent surveys.”

CMS proposes to survey top-performing facilities every 30 months, with no more than 36 months between surveys of any single facility. “We would reinvest the savings to strengthen our oversight and quality improvement efforts for facilities that are low performers,” Verma said.

“We would also continue to inspect facilities in response to complaints, which can occur at both low- and high-performing facilities, giving providers incentive to continuously monitor quality.”

Verma said the president’s budget proposal asks for $442.2 million in FY 2020 for the CMS Survey and Certification budget, an increase of $44.9 million above what Congress enacted in 2019.

In response, the American Health Care Association (AHCA) offered its backing of the push for more funding.

“AHCA supports the request for more funding to strengthen the survey process and to support State Survey Agencies and their work,” says David Gifford, MD, senior vice president of quality and regulatory affairs. “The consistency and timeliness of the survey process is important, and we support CMS’ work to address those issues. We share the CMS commitment to improving the lives of every resident in nursing homes across the country.”

Verma also said more needs to be done in making sure the survey process is standardized across the country, not dependent on geography for how the system works.

“Our nation is vast, and the states vary widely with regard to culture, geography, and climate. But high-quality health care should be the same, no matter the location,” she said. “This means that all SSAs must fairly and consistently apply CMS rules. Unfortunately, in recent years CMS has found variation across states in terms of the issues SSAs identify in nursing homes’ compliance with our requirements.”

See the entire blog post at

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