CMS issued a memorandum regarding changes to the Nursing Home Care Compare website. Of particular note for home care facilities is the posting of preliminary survey findings of nursing facilities prior to final resolution. Historically, when a facility disputed a survey deficiency, that finding is not posted publicly until the dispute process was complete.
As stated in the memorandum:
“As part of CMS’s commitment to transparency, consumers should have as much information about nursing homes as possible to support their healthcare decisions. Allowing consumers to see all of the citations a facility receives regardless of whether they are under [dispute] is consistent with our commitment to transparency and also enhances accountability and oversight of nursing homes. Therefore, CMS will post deficiency citations under [dispute] in each section of Nursing Home Care Compare that currently displays citations, and will indicate if a citation is under dispute.”
The number of actual deficiencies under dispute is generally small, but can include concerning instances of non-compliance such as “Immediate Jeopardy” citations which occur when the health and safety of residents could be at risk for serious injury, serious harm, serious impairment or death. In the past two years, there were 80 deficiencies across 67 surveys identified as Immediate Jeopardy (IJ) that went through the Informal Dispute Resolution (IDR/IIDR) process.
The Informal Dispute Resolution (IDR) process gives nursing homes an informal opportunity to dispute citations. Additionally, when CMS imposes a civil money penalty, providers have the opportunity to request an Independent IDR (IIDR). Section 488.331 of title 42 of the Code of Federal Regulations outlines the process for IDR and IIDR. The findings from the IDR or IIDR process are not binding on CMS.
Leading Age, a large association of age-focused organizations, urged CMS to reconsider the impact of posting deficiency citations prior to final resolution. In a letter to CMS Administrator Brooks-LaSure, Leading Age stated, “This policy change is deemed consistent with a commitment to transparency, but it threatens irresponsible use of critical information. We appreciate the push for transparency and accountability in nursing homes and support initiatives that will promote positive outcomes—posting disputed citations before resolution and finalization does not serve that purpose.” Leading Age also argued that the minimum 60- day delay to resolve a disputed citation may cause irreparable harm to nursing homes as those in need of imminent need of nursing home placement who are searching the CMS Home Care Compare site will see and rely on premature data to make decisions for themselves or their family members. As noted in the recent CMS memorandum, based on surveys that occurred within the past two years, there are over 300 citations under informal dispute that are 6 months or older and are still not posted on Nursing Home Care Compare.
CMS made clear that as disputed items are resolved, citations will be removed. Similarly, if the severity of a citation is reduced, the site will reflect the revised level. While the citations will be publicly displayed, CMS will not include them in the calculation of a facility’s star rating until the dispute is complete (and the survey is considered final). In order to be consistent in how citations are reported across different platforms, CMS will also include citations under “IDR/IIDR” on the QCOR website.
