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CMS Launches 'Comprehensive Review' of Nursing Homes Regulation

Analysis  |  By John Commins  
   April 16, 2019

CMS Administrator Seema Verma details a five-point plan to improve quality of care and regulatory enforcement at the nation's nursing homes.

The Centers for Medicare & Medicaid Services has launched a review of regulations and processes governing safety and quality of care in the nation's nursing homes, Administrator Seema Verma said.

"While we support and promote the private sector's critical role in our healthcare system, CMS' duty to monitor the safety of the nation's hospitals, nursing homes, and other providers, is a unique governmental task which lies at the core of government's role in healthcare," Verma said in a media release.

"I have directed my team at CMS to undertake a comprehensive review of our regulations, guidelines, internal structure, and processes related to safety and quality in nursing homes," she said.  

Verma said the review will focus on five areas:

Strengthen Oversight:

CMS will work with state survey agencies to oversee nursing homes. The SSAs visit and survey every Medicare and Medicaid participating nursing home in the nation at least annually to ensure they are meeting CMS' health and safety requirements as well as state licensure requirements. To be effective, SSAs must be fair and consistent in applying CMS rules, Verma said.

Enhance Enforcement

"We're strengthening our enforcement policies to hold nursing homes accountable for the care they provide. As part of this effort, we’re developing new ways to root out bad actors and repeat offenders," Verma said.

SSAs are conducting a portion of their unannounced after-hours and weekend inspections to focus on staffing problems during those times. SSAs will take appropriate enforcement actions against those facilities that fail to provide the required nurse staffing, Verma said.  

"We're also improving quality of life for nursing home residents. Too often, residents with dementia-related psychosis have been deemed to be unruly or difficult, and have been given antipsychotic sedative drugs in contravention of FDA guidelines. CMS has worked through our National Partnership to Improve Dementia Care in Nursing Homes to curb the inappropriate use of these drugs in nursing homes," Verma said.

"We're also committed to working with Congress to strengthen nursing home enforcement. The FY 2020 Budget also requests $442 million for Survey and Certification, a $45 million increase from the previous year," she said.

Increase Transparency

We're constantly working to make sure the information on Nursing Home Compare is as accurate and informative as possible. In April 2018, we incorporated data on nursing home staffing based from a new payroll-based journal (PBJ) system into Nursing Home Compare and the Nursing Home Five-Star Quality Rating System. The new PBJ data allows CMS to more accurately track staffing levels in nursing homes.  

CMS has also increased public awareness of nursing homes failing to meet our minimum health and safety standards. "Now, instead of publishing notices in local newspapers, we're publicizing instances in which CMS terminates our agreements with nursing homes due to poor quality on our website," Verma said. .

Improve Quality

CMS is developing quality measures that score providers based on patient outcomes, not adherence to processes, Verma said.  

CMS fines nursing homes that don’t comply and the agency recently launched an initiative to invest these Civil Money Penalty dollars in efforts to reduce adverse events, improve staffing quality and improve quality of care for residents with dementia.

Put Patients Over Paperwork

When administrative burden increases with little or no benefit, patients suffer because mountains of unnecessary paperwork keep providers from patients. Additionally, high administrative costs can make it difficult for facilities to operate, Verma said.

"We are developing our regulatory strategy in a way that puts patient quality and safety first while removing unnecessary burdens on providers that create staffing challenges and increase cost without increasing quality," she said. "We want to make sure providers spend time caring for residents instead of completing unnecessary paperwork."

“We're strengthening our enforcement policies to hold nursing homes accountable for the care they provide.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


CMS Administrator Seema Verma calls for more coordination of nursing home oversight with state survey agencies.

HHS is requesting an additional $45 million in the FY 2020 budget to strengthen nursing home enforcement.

Verma pledges to improve transparency, quality and compliance without undue paperwork burdens on nursing homes.

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