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Directed In-Services: Enforcement Remedy for Non-Compliant Nursing Homes

November 21, 2017
Compliance By Rodney Farley

With the Phase 2 Requirements of Participation effective date fast approaching, it's important that nursing homes gain a clear understanding of the Centers for Medicare and Medicaid Services' (CMS) guidance on successful survey outcomes. CMS's revision to the F-Tags, implemented as part of the roll out of the Reform of Requirements for Long Term Care Facilities, correspond to new regulatory sections. What's more is that the new F-Tag splits increase the likelihood for nursing homes to receive multiple citations.

 

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Enforcement Remedies for Non-Compliant Nursing Homes

While CMS announced they will “provide a one-year restriction of enforcement remedies for specific Phase 2 requirements and not invoke civil monetary penalties, denial of payment, and/or termination for non-compliant facilities, deficiencies will still be issued. Additionally, the agency may require a Directed Plan of Care or Directed In-Service as an alternate enforcement action.

Per Chapter 7, section 7502 of the State Operations Manual, Directed In-Service training is used as a first-line remedy to correct deficiencies and help facilities achieve substantial compliance. The regulations require facility staff to attend an in-service training program from a state-approved in-service training provider.

What to Do If an Enforcement Remedy Is Imposed

Should your facility be cited during survey, with the remedy of directed in-service, you should immediately procure a list of approved training providers from your State or regional office. Once an in-service training provider is selected, facilities must submit a copy of the proposed training program that is specific to the situation surrounding the survey citation, along with the plan of correction to the State Survey Agency for approval. Facilities must be aware of the 10-day window to respond. Failure to submit an acceptable plan of correction within the allotted time can result in penalties.

LW Consulting, Inc. can help on both fronts. Not only are we an in-service training provider, but we will work with you to develop an appropriate plan of correction. Additionally, we will identify if the citation is accurate or disputable. We can also assess whether or not the issue was isolated or a result of system issues. Either way, our experienced consultants will ensure staff are appropriately educated, develop a plan to prevent future citations and work with you to ensure operational processes are solid.

CMS will only be implementing Directed In-Services as an enforcement remedy for a limited time. Nursing homes should be aware of this and make sure their operations are in solid working order to ensure the success of future surveys.


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