HCFA officials said they will not permit a proposed South Dakota nursing home quality-assurance project in its current form because it does not have enough enforcement safeguards.
South Dakota had planned to apply for a five-year waiver from federal survey and certification requirements so the state's 110 nursing homes could participate in a project that would track clinical indicators and patient outcomes and satisfaction. The program would have less emphasis on survey and certification activities.
The American Health Care Association, a long-term-care provider group, is helping coordinate the project.
But Anthony Tirone, deputy director for survey and certification in HCFA's health standards and quality bureau, last week said such a project would be unacceptable if it proposes to replace existing inspection and certification requirements with a quality-assurance program.
Tirone commented on the project last week during the annual meeting of the National Citizens' Coalition for Nursing Home Reform in Washington.
AHCA officials previously have said that if nursing homes monitor their own quality indicators and are allowed to see how they comp are with their past performance and that of their peers, survey and certification will become less important.
Joan Bachman, administrator of the South Dakota office of healthcare facility licensure and certification, said the state has submitted only a preliminary proposal.
She said the state soon will submit a formal proposal that will retain survey and certification requirements but also will seek elimination of some detailed patient reviews that state offic ials believe do not help improve patient care.
"We feel very strongly that we have not given away anything in terms of oversight and we will verify compliance with regulations," Bachman said.
AHCA spokesman Dave Kyllo added: "It a ppears that HCFA has prejudged the whole waiver application before it's done."