In the Know

CMS to Include Warning Icon on Nursing Home Compare for Facilities Cited for Abuse
October 16, 2019
Alerts
Arnall Golden Gregory LLP

As part of its five-part approach to ensuring safety and quality in nursing homes, the Centers for Medicare and Medicaid Services (CMS) announced that as of October. 23, 2019, it would begin displaying a consumer alert icon next to the Nursing Home Compare listing for facilities that have been cited for incidents of abuse, neglect, or exploitation.

Specifically, CMS detailed in a September, 2019 update to its Nursing Home Compare, Five-Star Technical Users’ Guide that facilities would have an open palm icon in a red circle displayed next to their Nursing Home Compare listing if they received (a) an abuse citation where residents were found to be harmed (Scope/Severity Level G or higher) in their most recent standard survey or a complaint survey within the past 12 months, or (b) an abuse citation where residents were found to be potentially harmed (Scope/Severity Level D or higher) on the most recent standard survey or on a complaint survey within the past 12 months and on the second most recent standard survey or on a complaint survey conducted between 12 and 24 months.

Additionally, nursing homes that receive the abuse icon will have their health inspection rating capped at a maximum of two stars, which will necessarily cap their overall rating at four stars. CMS has stated that it will update the icon status on a monthly basis to guard against facilities being flagged for longer than necessary if they have remedied the underlying causes that led to the abuse citation(s).

CMS categorizes the move as an effort to promote transparency and clarify the nuances associated with a facility’s overall quality of care. Unsurprisingly, however, provider associations disagree. Both the American Health Care Association (AHCA) and LeadingAge issued press releases in response to the announcement pointing out the lack of a “standard and rational definition of both abuse and neglect,” and a “flawed survey system, in which interpretations of regulations are notoriously inconsistent.”

The liberalization of the abuse provisions in the 2016 overhaul of the Medicare Nursing Home Requirements for Participation as well as historic variations among CMS Regional Offices, State Survey Agencies and even individual surveyors, in interpreting and enforcing the Requirements for Participation, are not made readily apparent by CMS to residents or their families. As a result, the agency’s alert icon, rather than promoting transparency and clarifying nuances, runs the risk of over-simplifying the issue of abuse and neglect in the minds of consumers.