Mock State Survey (Regulatory)

Overview:

The Centers for Medicare & Medicaid Services (CMS) is the component of the Federal Government's Department of Health and Human Services that oversees the Medicare and Medicaid programs.

State Governments oversee the licensing of nursing homes. In addition, States have a contract with CMS to monitor those nursing homes that want to be eligible to provide care to Medicare and Medicaid beneficiaries. Congress established minimum requirements for nursing homes that want to provide services under Medicare and Medicaid.

CMS contracts with each State to conduct on-site inspections to determine whether each nursing home meets the minimum Medicare and Medicaid quality and performance standards. The State conducts inspections of each nursing home participating in the Medicare and/or Medicaid program on average once a year. If the nursing home is performing poorly, however, the State inspectors may go in more frequently. The State is also commissioned with investigating complaints about nursing home care.

During the nursing home inspection, the State looks at many aspects of quality. The inspection team observes resident care processes, staff/resident interaction and environment. 

The inspection team consists of trained inspectors, including at least one registered nurse. This team evaluates whether the nursing home meets individual resident needs. In addition, fire safety specialists evaluate whether a nursing home meets standards for safe construction. When an inspection team finds that a home does not meet a specific regulation, they issues a deficiency citation.

The regulations cover a wide range of aspects of resident life, from specifying standards for the safe storage and preparation of food to protecting residents from physical or mental abuse or inadequate care practices.

There are over 150 regulatory standards that nursing homes must meet at all times.  

Potential Risks to Provider:

Depending on the nature of the problem, CMS can take action against the nursing home. The law permits CMS to take a variety of actions; for example, CMS may fine the nursing home, deny payment to the nursing home, assign a temporary manager, or install a State monitor. CMS considers the extent of harm caused by the failure to meet requirements when it takes an enforcement action. If the nursing home does not correct the sited problems, CMS will terminate their agreement with the nursing home. As a result, the nursing home is no longer certified to provide care to Medicare and Medicaid beneficiaries. Any beneficiaries residing in the home at the time of the termination are transferred to other certified facilities.

How can Harmony Healthcare International (HHI) help?

HHI provides Mock Regulatory Survey to assist with the survey readiness, and identify areas of opportunity to ensure deficiency free surveys.

The regulatory review performed by HHI includes chart reviews, direct observation of care, staff interviews, in addition to policy/procedure review. The following are areas HHI Consultants review as a part of the Mock Survey process:

At the end of the Mock Regulatory Survey, an exit meeting simulating the state survey process is conducted. This meeting allows the HHI Consultant to present results to all disciplines within the facility at once. A full report containing findings and recommendations for improvement is made available to facility leadership team within a short time frame after the survey.