Medicare and Medicaid: Stronger Enforcement of Nursing Home Requirements Needed
HRD-87-113
Published: Jul 22, 1987. Publicly Released: Sep 18, 1987.
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Highlights
In response to a congressional request, GAO investigated the enforcement of Medicare and Medicaid requirements for nursing homes, focusing on the: (1) extent and potential effect of repeated noncompliance; and (2) adequacy of enforcement actions taken by state and federal agencies.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Congress should amend title XIX of the Social Security Act to preclude nursing homes terminated from the Medicaid program from being readmitted to the program unless the state survey agency can establish that the deficiencies that led to termination have been removed, and it has reasonable assurance that they will not recur. |
Closed – Implemented
|
OBRA 87 strengthened enforcement provisions to help preclude terminated facilities from being readmitted to the Medicaid program with uncorrected deficiencies. |
| Congress should enact legislation such as S.1108, H.R. 2270, or H.R. 2770, to give the Department of Health and Human Services and the states additional alternatives for enforcing compliance with nursing home requirements. |
Closed – Implemented
|
OBRA 87 established authority for a wide range of alternative sanctions, including civil penalties and bans on admissions. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should revise the repeat deficiency provisions of Medicare and Medicaid regulations to limit the use of decertification to those instances where a nursing home cannot adequately justify repeat deficiencies that seriously threaten patient health and safety. |
Closed – Implemented
The Department of Health and Human Services (HHS) addressed this recommendation in regulations implementing the Omnibus Budget Reconciliation Act, but disagreed that it should require written justification for any repeat deficiency.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should revise the repeat deficiency provisions of Medicare and Medicaid regulations to require nursing homes to justify all repeat deficiencies, including those reported at the element level or subsequently corrected. |
Closed – Not Implemented
HHS does not believe that requiring written justification for all repeat deficiencies would provide any meaningful incentive to maintain compliance.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator of the Health Care Financing Administration to encourage states to apply state licensing sanctions to nursing homes with repeat deficiencies that are not adequately justified. |
Closed – Not Implemented
The passage of OBRA 87 established at the federal level the alternative sanctions this recommendation was aimed at utilizing.
|
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Topics
Eligibility criteriaFines (penalties)Institution accreditationMedicaidMedicareNoncomplianceNursing homesPatient care servicesRegulatory noncompliancePatient care