A long-term-care provider group says federal regulators are reneging on a promise to delay imposing new penalties on nursing homes found to be violating quality regulations.
HCFA, however, says there was no deal to phase in implementation of the quality inspection and enforcement regulations, scheduled to take effect July 1. The rules provide for yearly inspections and fines and other penalties against nursing homes that fail to meet quality standards.
The dispute blew up last week after American Health Care Association Executive Vice President Paul Willging told the group's board of directors and state organization executives in a memo that HCFA had agreed to wait to impose fines until the agency had tested its inspection procedures.
That followed statements from HHS Secretary Donna Shalala at the AHCA's congressional conference in Washington last month that HCFA would carefully monitor implementation of the regulations (June 19, p. 12).
In response, HCFA officials said they told the trade group that only in cases where violations didn't immediately jeopardize patients and weren't chronic would nursing homes have 90 days to fix up problems before penalties are imposed.
"What we tried to explain is that we will have an opportunity, before any provider has to pay a fine or have a new admission denied, to look at the system.....and that we want (the AHCA) to participate in looking at the system," said Barbara Gagel, director of HCFA's health standards and quality bureau.
But Willging contends that HCFA hasn't tested its inspection procedures, as required by the 1987 law that authorized the regulations.
When the AHCA conducted its own test, only 18% of the nursing homes met the test of being in "substantial compliance" with quality regulations, the category of violation that would not trigger immediate penalties.
Willging said those findings prove how hard it will be for nursing homes to comply-despite a HCFA assertion that most nursing homes would be in compliance-and the need for the agency to test its inspection procedures. But Gagel argued that HCFA can't test its procedures until it begins inspections.