Expect the Unexpected: This week’s Top Newsmakers in Quality and Regulatory Affairs

OIG Releases Report on Survey Process Review

The Department of Health and Human Services Office of the Inspector General (OIG) released a report which summarized findings of nine previous reports the OIG issued from July 2015 through May 2018. The OIG reviewed nine selected State agencies (WA, OR, AZ, MO, KS, NY, NC, FL, NE) to determine the verification process used to ensure nursing centers had corrected deficiencies and were in substantial compliance. According to the findings section of the report, of the nine selected states, two State agencies verified nursing homes' correction of deficiencies identified during surveys in a manner consistent with Federal requirements. The remaining seven states did not consistently verify correction of deficiencies following Federal requirements. Further, in at least one State, there were inconsistent responses from State "field offices" and State surveyors regarding routine practices for obtaining evidence of correction. What does this mean for you? CMS has committed to reviewing current guidance to States related to all issues raised by the OIG.  This review could potentially result in:
· Changes to the State Operations Manual regarding certifying substantial compliance;
· Increased on-site visits by surveyors to ensure deficiencies have been corrected; and
· Increased scrutiny from Regional Offices and CMS about State agency compliance with updated/changed
      requirements to certification of substantial compliance.
AHCA and MHCA will continue to monitor and advocate on behalf of members regarding any proposed changes to the State Operations Manual. 
Frequently Asked Questions: Payroll Based Journal (PBJ)
If a nurse is working 8 hours and the center reports 7.5 hours (due to the 30-minute meal time exclusion) will the provider be penalized for not having an RN on staff for 8 hours?
· CMS auditors are aware of this situation and as long as the facility can provide proof that the RN was onsite for 8 consecutive hours, reporting time for 7.5 is not going to be an issue.
Do meal times need to be excluded even if the staff eats with the residents or works through lunch?
· Per the PBJ Policy Manual, facilities must deduct the time allotted for meals from each employee's daily hours. A 30-minute meal break must be deducted from an employee's shift whether or not the employee actually takes a meal break. We realize that this policy is frustrating for members and AHCA continues to advocate for changes to be made to it. However, until such time that a policy change is made providers must exclude meal times to avoid being penalized.
· Providers may consider having two separate timekeeping systems to comply with both CMS's PBJ requirements and the Department of Labor's (DOL) Fair Labor Standard Act. Manually editing the data to reflect the needs for both PBJ reporting and payroll runs the risk of human error and documentation challenges during an audit by either CMS or DOL. If separate timekeeping systems is not possible, as a best practice, providers should have a system that preserves the original record before any edits are made.
Which residents do we need to report hours for?
· Hours should be reported for SNF/NF residents, essentially, those that have an MDS assessment submitted for them.
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On February 26th, 2019 from 1:00-2:00 ET McKnight's will be offering a free educational opportunity to discuss the creation of an employee-centric culture to improve retention and reduce staff engagement challenges. In this free webinar you will learn how to create a transparent, engaged and thriving culture to combat employee turnover and beat the growing workforce shortage. NAB credit is being offered. REGISTER HERE.
Staff Contact:
Danielle Watford
Director of Quality Improvement & Regulatory Affairs