A number of survey- and license-related issues are popping up during the shutdown. Following is what we know to-date.

1. Individual Licenses – State agencies that provide individual licenses are all shut down. If a nurse, therapist, administrator, cosmetologist, etc. has a license that expires during the shutdown, our information is that they are no longer permitted to perform their professional functions until such time as they can provide a valid current license.
2. Building/Program Licenses/Registrations – Our information is that these will not be cancelled, but will be extended until such time as they are able to be updated/renewed or are rescinded due to investigated non-compliance.
3. Home Care Agency Surveys (Class F and Class A – Licensed Only) – These surveys and resurveys will not be conducted during the shutdown, as they are not tied to any federal requirements.
4. Nursing Home Surveys –
1. Standard Surveys – Minnesota Department of Health staff will not be conducting routine “annual” surveys during the shutdown.
2. Complaint Surveys – A small number of Office of Health Facility Complaint (OHFC) staff are available to triage complaints and conduct limited on-site investigations and abbreviated surveys.
3. IDR and IIDR – Our information from CMS Region V is that these will simply “stack up” during the shutdown. Obviously this could change depending on the length of the shutdown. If providers receive a 2567 and they wish to initiate an IDR or IIDR, they should attempt the notification. If the notification is not possible due to the shutdown, they should document this.
4. If you have recently had a survey but have not received a final 2567 – CMS Region V suggests that the facility immediately begin implementing corrective actions based on the information from the exit conference (hopefully including a draft 2567). The facility should also begin to formulate the outline of a plan of correction (POC) to expedite the process when MDH staff returns to work.
5. If you have recently had a survey and have sent in your POC, what will happen? – This is unclear. MDH is operating with a skeletal staff, and these most likely will not get processed. We do not know if/when this responsibility might be shifted to staff at CMS Region V.
6. What if I do not get surveyed within the maximum federal timeframe of 15 months? – According to CMS Region V, there are no implications to the provider if the 15-month timeframe is exceeded (there may, however, be implications for MDH).
7. If CMS Region V staff conducts surveys in Minnesota, will the federal surveyors be trained on the QIS process and utilize the QIS process? – According to CMS Region V, the answer is yes.
8. What if I am waiting for a resurvey (follow-up to a prior survey to verify compliance)? – There are currently approximately 60 Minnesota nursing facilities in this situation. CMS Region V staff is sorting through these and prioritizing them based on indicated dates of compliance, scope and severity levels, number of resurveys already failed, and optional or mandatory remedies. CMS Region V will utilize methods to verify compliance such as telephone, fax, or mail when such methods are reasonable based on the facts of the survey and POC. CMS Region V staff may also come on-site to Minnesota facilities when the facts support the need for on-site verification to prove compliance.
9. How will remedies be applied during the shutdown? – CMS Region V staff has indicated that remedies will be addresses on an individual case situation. CMS Region V may need to “bend” a few rules so a facility is not unduly harmed (for example: extended daily civil money penalties, per instance civil money penalties, denial of payment for new admissions, etc.) as a result of MDH staff or CMS staff not conducting timely revisits.
10. What is the status of the new federal 2-hour reporting requirements? – CMS is aware that MDH is required to provide joint training on this new requirement. Joint training is not possible with MDH staff off the job. Therefore, these new requirements will not be implemented in Minnesota during a shutdown. Many other states are also struggling with this new regulation, and we anticipate CMS will release another memo in the near future to clarify expectations.

That is what we know right now. Things could change if the shutdown continues for an extended period of time. CMS indicates the closest thing they have experienced that is similar in scope to this situation is when the Louisiana state survey agency was unavailable to perform contracted services during Hurricane Katrina . . . indicating that this is somewhat uncharted territory.

If you have a specific question about your particular survey situation, nursing home providers should contact Heather Lang (312-886-5344) at CMS Region V or Tamika Brown (312-353-1502) at CMS Region V, and let Doug Beardsley (dbeardsley@careproviders.org) know how your situation will be handled by CMS.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org

Resources

Our Sponsors