Nursing Homes:

Federal Efforts to Monitor Resident Assessment Data Should Complement State Activities

GAO-02-279: Published: Feb 15, 2002. Publicly Released: Mar 18, 2002.

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Nursing homes that participate in Medicare and Medicaid must periodically assess the needs of residents in order to develop an appropriate plan of care. Such resident assessments are known as the minimum data set (MDS). According to officials in the 10 states with MDS accuracy review programs in operation as of January 2001, these programs were established to set Medicaid payments and identify quality of care problems. Nine of the 10 states conduct periodic on-site reviews in all or a significant portion of their nursing homes to assess the accuracy of the MDS data. These reviews sample a home's MDS assessments to determine whether the basis for the assessments is adequately documented in residents' medical records. These reviews often include interviews of nursing home personnel familiar with residents and observations of the residents themselves. States with separate MDS review programs identified various approaches to improve MDS accuracy. State officials highlighted the on-site review process itself and provider education activities as their primary approaches. State officials also reported such remedies as requiring nursing homes to prepare a corrective action plan or imposing financial penalties on nursing homes when serious or extensive errors in MDS data are found. Following the 1998 implementation of Medicare's MDS-based payment system, the Health Care Financing Administration began its own review program to ensure the accuracy of MDS data.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: CMS indicated that its planned approach to develop analytic tools to monitor and compare state activities is well positioned to ensure data accuracy and that additional efforts, such as those GAO recommended, are unnecessary. Thus, it does not plan to implement this recommendation.

    Recommendation: With the goal of complementing and leveraging the considerable federal and state resources already devoted to nursing home surveys and to separate MDS accuracy review programs, the administrator of CMS should review the adequacy of current state efforts to ensure the accuracy of MDS data, and provide, where necessary, additional guidance, training, and technical assistance.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

  2. Status: Closed - Not Implemented

    Comments: CMS indicated that its current plans for monitoring state agency activities (i.e., through its DAVE contract) will provide adequate information about state agency activities. It noted that this methodology will result in a more comprehensive assessment of state activities related to MDS accuracy than could be obtained through the comparative survey process,and thus does not plan to use comparative surveys as GAO recommended.

    Recommendation: With the goal of complementing and leveraging the considerable federal and state resources already devoted to nursing home surveys and to separate MDS accuracy review programs, the administrator of CMS should monitor the adequacy of state MDS accuracy activities on an ongoing basis, such as through the use of the established federal comparative survey process.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

  3. Status: Closed - Not Implemented

    Comments: CMS indicated that collecting the additional documentation suggested by GAO's recommendation would be duplicative and would create an unnecessary burden for nursing homes. Thus, it indicated that it would not implement this recommendation.

    Recommendation: With the goal of complementing and leveraging the considerable federal and state resources already devoted to nursing home surveys and to separate MDS accuracy review programs, the administrator of CMS should provide guidance to state agencies and nursing homes that sufficient evidentiary documentation to support the full MDS assessment be included in residents' medical records.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

 

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