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Highlights

GAO was asked to assess the effectiveness of nursing home oversight by considering the effect of a unique Arkansas law that requires county coroners to investigate all nursing home deaths. Coroners refer cases of suspected neglect to the state survey agency and law enforcement entities such as the state Medicaid Fraud Control Unit (MFCU). The Centers for Medicare & Medicaid Services (CMS) contracts with survey agencies in every state to periodically inspect nursing homes and investigate allegations of poor care or neglect. MFCUs are charged with investigating and prosecuting resident neglect. GAO examined (1) the results of Arkansas coroner investigations, (2) the state survey agency's experience in investigating coroner referrals, and (3) whether weaknesses in state and federal nursing home oversight identified in prior GAO reports were evident in the survey agency's investigation of coroner referrals.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services 1. The Administrator of CMS should revise the agency's current policy on citing deficiencies for past noncompliance with federal quality standards by holding homes accountable for all past noncompliance resulting in harm to residents, not just care problems deemed to be egregious.
Closed - Implemented
On June 13, 2005, CMS sent out draft guidance on past noncompliance to state survey agencies, regional offices, provider associations, and others for comment. The proposed guidance clarifies the current guidance, but only holds nursing homes accountable for past acts involving immediate jeopardy to residents, not actual harm, as GAO recommended. Update: In October 2005, CMS issued a revised past noncompliance policy that holds homes accountable for all past noncompliance resulting in harm to residents, clarifies how to address recently identified past deficiencies, eliminates the use of the term "egregious," and clarifies the methods for determining whether past noncompliance has been corrected.
Centers for Medicare and Medicaid Services 2. The Administrator of CMS should revise the agency's current policy on citing deficiencies for past noncompliance with federal quality standards by developing an approach for citing such past noncompliance in a manner that clearly identifies the specific nature of the care problem both in the OSCAR database and on CMS's Nursing Home Compare Web site.
Closed - Implemented
CMS has sent out draft guidance for comment on its revised non-compliance policy. The draft guidance indicates that, starting on November 1, 2005, CMS will discontinue the use of data tag F698, which signifies past noncompliance. CMS indicated it is proceeding to modify the data system so that the specific nursing home survey data tag for which there was past noncompliance is appropriately identified. However, the specific problems for which past noncompliance was cited will not be posted on CMS's Nursing Home Compare web site until sometime in 2006 due to a backlog of higher priority programming requirements. Update (2006): In December 2005, we reported that CMS plans to enhance the information on its Nursing Home Compare Web site to include the specific nature of the past noncompliance in 2007. In August 2007, I followed up with Ed Mortimore of CMS and learned that the information has been reported on the Nursing Home Compare Web site since the fall of 2006.

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