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Hospital Inspections to Resume In Full

By Doug Desjardins  
   October 18, 2013

The effects of the government shutdown will be felt for weeks as state and federal officials play catch-up on hospital inspections, re-certifications, and other routine work.

With a temporary federal budget deal Wednesday finally ending the 16-day government shutdown, state and federal officials have some catching up to do to make up for time lost.

At the state level, some health departments will be dealing with a backlog of federal inspections postponed during the shutdown. Some hospital and nursing home inspections by officials from the Centers for Medicare & Medicaid Services and state officials who conduct inspections for CMS could not be conducted.

During the shutdown, state officials were limited to pursuing only what CMS described as "complaints that are triaged as credible allegations of immediate jeopardy or harm to an individual" and that those cases "should continue to be assessed and investigated according to CMS protocols."

State agencies were also allowed to revisit a hospital or other facility if the revisit was required to prevent a facility from shutting down and creating a situation "that is likely to threaten the safety of human life, such as creating access-to-care or other serious, immediate, and negative consequences to beneficiaries."

Surveys and certifications that were prohibited during the shutdown included visits for initial Medicare certifications and investigation of complaints that did not put patients or facilities in immediate jeopardy or harm.

Contingency Funding
Before the shutdown went into effect, the U.S. Department of Health and Human Services created a contingency plan for CMS under which it was authorized to "incur obligations up to an aggregate $8.6 million in Medicare funds covering initial S&C [survey and certification] activities up to the first 3 or 4 weeks of the fiscal year" with specific funding levels appropriated to each state.

In Texas, a spokesperson for the Texas State Department of Health said the department had to delay only a handful of planned inspections during the first two weeks of October. "We were just beginning to plan our federal workload for the next few months when the furlough occurred," said Christine Mann. "So we had only four or five hospital re-certifications planned that we had to put on hold." Mann said the department will reschedule those inspections.

In Florida, the state Agency for Health Care Administration said it didn't have to postpone or delay any federal inspections. "There are no surveys overdue for recertification," said Shelisha Coleman, press secretary for the AHCA.

Hospital Compare Update Delayed
CMS also had to cancel its routine update of data for its Hospital Compare website. CMS was due to refresh data on the site Oct. 10 but cancelled the update due to the government shutdown. In a statement, it stated that "its next scheduled release of the website is set for Dec. 12. At that time, CMS will update the readmission and complications data as well as release several new measures."

In another delay, the American Hospital Association pushed its deadline for hospitals to submit data for its quarterly RACTrac survey to Oct. 18. The web-based survey is designed to gauge the impact of Medicare's Recovery Audit Contractor program on hospitals and advocate for needed changes.

The Senate-crafted measure that re-opened the federal government and temporarily lifted the nation's debt ceiling was approved by an 81-18 margin in the Senate and 285-144 in the House of Representatives. The measure will fund the federal government at sequestration levels through Jan. 15 and raise the debt ceiling through Feb. 8.

Effects on PPACA
While the government shutdown was triggered in larger part by demands in Congress to defund or delay the Patient Protection and Affordable Care Act, the measure that re-opened the government included just one minor change. Under the measure, the HHS must ensure that state and federal health insurance exchanges verify that people applying for federal subsidies to purchase insurance on the exchanges are eligible to receive them. HHS must also submit a report to Congress by Jan. 1, 2014 that describes the measures that exchanges have implemented to verify eligibility and prevent fraud.

House Republicans are expected to continue their push for changes to healthcare reform while legislators on both sides of the aisle pursue a more long-term solution for the federal budget and debt ceiling.

In an Oct. 16 statement, House Speaker John Boehner (R-OH) said the GOP "will rely on aggressive oversight that highlights the law's massive flaws and smart, targeted strikes that split the legislative coalition the president has relied on to force his healthcare law on the American people."

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