Chuck Grassley

United States Senator from Iowa

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Grassley Continues Seeking Answers on Nursing Home Oversight Failures

Sep 19, 2018

Grassley Continues Seeking Answers on Nursing Home Oversight Failures

WASHINGTON – U.S. Sen. Chuck Grassley of Iowa, chairman of the Senate Judiciary Committee, continues to press for answers from the federal agency charged with overseeing the quality of care in nursing homes and to question findings of preventable harm to nursing home residents. Today he sent a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma seeking additional information regarding CMS oversight efforts of nursing homes, including Timely Mission Nursing Home in Buffalo Center, Iowa. Grassley’s letter follows a letter he received from Administrator Verma on August 31, 2018, which addressed some concerns Grassley outlined in a July 26, 2018 letter after it was reported that an elderly woman passed away seemingly due to lapses in care by staff at the Timely Mission Nursing Home.

“Over the past 20 years, GAO has reported on poor quality nursing home care and the lack of federal and state oversight of nursing homes. In addition, OIG (the Office of the Inspector General) found that one-third of Medicare beneficiaries at nursing homes experienced some type of harm during their stay and nearly 60 percent of the events were either clearly preventable or likely preventable. Finally, news reports have revealed that individuals with a history of settling claims of Medicare and Medicaid fraud have been able to continue to participate in CMS programs,” Grassley wrote.

“Although CMS has recently begun to audit nurse staffing, it does not have a plan to audit other quality data. Without sufficiently reliable reporting data it is difficult to ascertain the accuracy of government findings which, in turn, creates challenges to creating and implementing necessary policy fixes.”

Grassley has been an advocate for seniors throughout his time in Congress, particularly through his oversight work. In 2017, Grassley pressed CMS for answers on why it failed to ensure that nursing home abuse and neglect cases are reported to law enforcement as required, as well as its lack of urgency in responding to an early alert from the agency watchdog on the problem. Grassley also called on  social media companies to explore how they could stop users from posting humiliating and demeaning photos of vulnerable individuals after reports surfaced of nursing home workers in at least 18 facilities taking unauthorized photos of elderly residents.

Also last year, Grassley introduced the Elder Abuse Prevention and Prosecution Act, which became law. The law enhances enforcement against perpetrators of crimes targeting senior citizens. Specifically, it increases training for federal investigators and prosecutors and calls for the designation of at least one prosecutor in each federal judicial district who will be tasked with handling cases of elder abuse. It also ensures that the Federal Trade Commission’s Bureau of Consumer Protection and the Department of Justice will both have an elder justice coordinator and increases penalties for perpetrators.

Text of the letter is available here and below.

The Honorable Seema Verma

Administrator

Centers for Medicare and Medicaid Services

 

Dear Ms. Verma:

Thank you for your letter dated July 26, 2018, in response to my inquiry regarding the Timely Mission Nursing Home in Buffalo Center, Iowa.  While many nursing homes provide excellent care, I remain concerned about CMS’s efforts to ensure quality nursing home care to our most vulnerable citizens. 

CMS defines the conditions of participation for Medicare and Medicaid and is the agency responsible for overseeing that nursing home residents receive quality care. CMS also depends upon the efforts of state survey agencies to verify that nursing homes meet federal standards for quality and safety.  In order for such a system to work, there must be extensive communication and shared responsibility between federal and state partners.

Reports issued by the Department of Health and Human Services’ Office of Inspector General (OIG) and the Government Accountability Office (GAO), along with press reports of abuse and neglect occurring in nursing homes, raise questions as to how well this shared responsibility is working. Over the past 20 years, GAO has reported on poor quality nursing home care and the lack of federal and state oversight of nursing homes. In addition, OIG found that one-third of Medicare beneficiaries at nursing homes experienced some type of harm during their stay and nearly 60 percent of the events were either clearly preventable or likely preventable. Finally, news reports have revealed that individuals with a history of settling claims of Medicare and Medicaid fraud have been able to continue to participate in CMS programs. That very example showed itself in Florida when some residents died in a nursing home that had been subjected to previous fines. These outcomes are unacceptable. 

An October 2015 GAO report and 2018 testimony updating that report, provides an overview of key trends in nursing home quality data, which GAO had concluded were “mixed results.” GAO found that “data issues complicated CMS’s ability to assess nursing home quality trends.” For example, the number of complaints and nursing home deficiencies reported varied by state due to different reporting mechanisms, which complicated nationwide comparisons. In addition, GAO found that CMS did not regularly audit quality data such as nurse staffing and clinical data. Although CMS has recently begun to audit nurse staffing, it does not have a plan to audit other quality data. Without sufficiently reliable reporting data it is difficult to ascertain the accuracy of government findings which, in turn, creates challenges to creating and implementing necessary policy fixes.

Importantly, CMS has made efforts to provide additional guidance to nursing homes to help detect and reduce harm to patients. Moreover, according to GAO, in November of 2017, the U.S. Department of Health and Human Services (HHS) implemented a new national electronic survey to better document nursing home deficiencies across the states.   All of these efforts promise improved nursing home quality and I am anxious to see measurable outcomes and lasting results. With that in mind, please answer the following questions no later than October 3, 2018.

  1. In addition to the new national electronic survey to document nursing home deficiencies, what other actions has CMS taken to improve the quality and timeliness of state reporting?
  2. When will CMS evaluate the impact of the new national electronic survey?  When complete, please provide the results of the survey. 
  3. With respect to the dependence on data collection to determine trends in the quality of nursing home treatment, please explain the most effective methods CMS believes are necessary to improve data collection and what steps CMS has taken to implement those methods.  
  4. What steps have been taken to make the Nursing Home Compare site more user friendly?
  5. What authority does CMS have to prevent individuals or companies with histories of settling Medicare and Medicaid fraud claims from continuing to participate in government programs?  Does CMS have the ability to monitor these individuals, companies and their facilities or completely expel them from the programs?  If not, please explain what additional authorities are needed to prevent repeat bad actors from abusing government programs and patients.
  6. In light of the HHS OIG’s work in the nursing home space, does CMS regularly interact with the OIG to identify problematic facilities and work toward a proper patient-centered solution?  Please describe your relationship with the OIG in that regard.

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