Office of Inspector General Releases FY 2017 Work Plan for Nursing Homes and Hospice

PUBLISHED: Nov 18, 2016
Source: Office of Inspector General

The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued its Work Plan for fiscal year (FY) 2017 summarizing new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. Today’s StayAlert! Notice reviews those aspects of the Work Plan specific to nursing homes and hospice.

Below is a summary of some of the areas that OIG will focus on for nursing homes and hospices in 2017. See the OIG’s Work Plan for a complete listing of focus areas.

Nursing Homes:

  • (NEW) Nursing Home Complaint Investigation Data Brief: All nursing home complaints categorized as immediate jeopardy and actual harm must be investigated within a 2- and 10-day timeframe, respectively. A 2006 OIG report found that State agencies did not investigate some of the most serious complaints within these required timeframes. OIG will determine to what extent State agencies investigate the most serious nursing home complaints within the required timeframes.
  • (NEW) Skilled Nursing Facilities Unreported Incidents of Potential Abuse and Neglect: OIG will assess the incidence of abuse and neglect of Medicare beneficiaries receiving treatment in SNFs and determine whether these incidents were properly reported and investigated in accordance with applicable Federal and State requirements.
  • (NEW) Skilled Nursing Facility Reimbursement: Previous OIG work found that SNFs are billing for higher levels of therapy than were provided or were reasonable or necessary. OIG will review the documentation at selected SNFs to determine if it meets the requirements for each particular resource utilization group.
  • (NEW) Skilled Nursing Facility Adverse Event Screening Tool: OIG will describe the purpose, use, and benefits of the SNF adverse event trigger tool and the guidance document released by IHI, including the methodology for developing the instrument and the instrument’s use in developing the February 2014 report findings. The product will also describe the contributions of OIG and IHI. The goal of this product is to disseminate practical information about the tool for use by those involved with the skilled nursing industry.
  • (REVISED) National Background Checks for Long-Term-Care Employees — Mandatory Review: The Accountable Care Act (ACA) requires OIG to conduct an evaluation of this grant program, known as the National Background Check Program, after its completion (ACA § 6201). For States that closed their grants in the preceding year, OIG will review the procedures States implemented for long-term-care facilities and providers to conduct background checks on prospective employees who would have direct access to patients.

Hospices:

  • (NEW) Medicare Hospice Benefit Vulnerabilities and Recommendations for Improvement: A Portfolio: OIG and others have identified vulnerabilities in payment, compliance, and oversight as well as quality-of-care concerns, which can have significant consequences both for beneficiaries and for the program. OIG will summarize OIG evaluations, audits, and investigative work on Medicare hospices and highlight key recommendations for protecting beneficiaries and improving the program.
  • (NEW) Review of Hospices’ Compliance with Medicare Requirements: OIG will review hospice medical records and billing documentation to determine whether Medicare payments for hospice services were made in accordance with Medicare requirements.
  • (NEW) Hospice Home Care — Frequency of Nurse On-Site Visits to Assess Quality of Care and Services: OIG will determine whether registered nurses made required on-site visits to the homes of Medicare beneficiaries who were in hospice care.

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