Regulatory Preparedness

Overview:

Preparing for a Joint Commission Survey, Commission on Accreditation of Rehabilitation Facilities (CARF) or Regulatory State Survey can be a challenging process for any healthcare provider. At a minimum, a facility familiarize itself with current standards, examine current processes, policies and procedures relative to the standards and prepare to improve any areas that are not currently in compliance. Nursing homes are certified to provide services to eligible Medicare and Medicaid beneficiaries and are expected to meet federal regulations.

During surveys and inspections, interdisciplinary teams evaluate the care and services provided to residents in accordance with regulatory requirements. Prior to beginning a survey, team members review the nursing home's background. They look at previous survey results, complaint investigations, occurrence reports and quality indicators that give information specific to each facility. They also consult with the ombudsmen assigned to that facility to get an idea of whether there are special concerns or problems that they should be aware of during the survey.

Both accreditation and Regulatory State Surveys are unannounced. Once in the facility, surveyors observe what is going on in the healthcare facility, review medical records and other documents, and interview residents, family members and facility staff. The surveyors summarize their observations to facility staff at the conclusion of the visit.

In case of Regulatory State Survey the nursing home receives a letter and a survey form (Form 2567). They are given ten days to respond with a plan of correction. The plan of correction is reviewed for acceptance. A follow-up survey, the revisit, takes place to verify the accurate and timely implementation of the plan of correction.

Potential Risks to Providers:

Failure to obtain Joint Commission/CARF accreditation may cause a facility to lose their Medicare/Medicaid contract thus cause significant loss of income. Conversely, depending on the nature of the State Survey findings, Medicare can take action against the nursing home. In severe cases Medicare may terminate its agreement with the nursing home. As a result, the nursing home is no longer certified to provide care to Medicare and Medicaid beneficiaries.

How can Harmony Healthcare International (HHI) help?

Harmony Healthcare International (HHI) has developed processes and tools to help healthcare providers prepare for inspections and successfully obtain Joint Commission, CARF accreditations as well as pass Regulatory State surveys.

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