The nursing home industry last week came under fire from HCFA and Congress, and it expects more of the same in the months to come.
HCFA Administrator Nancy-Ann Min DeParle kicked off the onslaught, announcing that her agency would combat quality-care breaches in nursing homes with tougher fines and swifter scrutiny.
HCFA then issued a final regulation that allows inspectors to immediately slap civil monetary penalties on nursing homes that do not comply with Medicaid quality standards. The facilities can now be fined up to $10,000 per incident on top of other existing fines, with no grace period for fixing the problem.
HCFA is also requiring states to investigate within 10 days complaints alleging harm to residents. Previously, no deadline existed.
In 1997, about 15,600 U.S. nursing homes were certified under the Medicaid program. Total state and federal Medicaid spending on nursing homes in 1996, the most recent year for which figures were available, was $37.5 billion. In 1999 projected payments will total $42 billion.
A spokeswoman for the Texas Department of Human Services, the state agency that surveys nursing homes, said she welcomed HCFA's new rules.
But industry representatives said that higher fines would burden nursing homes, which are already reeling from changes in Medicare reimbursement. "You punish a facility for a mistake, you end up taking funds away from a facility that could have been used to correct the problem," said Dennis Bozzi, president of Life Services Network of Illinois, a long-term-care trade group.
Two days after issuing the new regulations, HCFA ended up in the hot seat when Congress' investigatory arm, the General Accounting Office, released the latest in a series of reports criticizing HCFA's enforcement efforts.
The GAO report, commissioned by the Senate Special Committee on Aging, said that many fines levied against nursing homes are never collected because of the lengthy appeals process.
The GAO recommended streamlining the process for appealing fines and disallowing reimbursement to nursing homes that have been terminated from government payment programs until the facilities comply with quality standards.
It's the first in an expected dozen or more GAO reports on the industry due out this year.
Separately last week, the Senate unanimously approved a bill shielding Medicaid patients from nursing home eviction. The bill requires nursing homes withdrawing from the Medicaid program to continue caring for current residents for as long as the residents need it.
The House of Representatives approved the same bill earlier this month.
About 70% of nursing residents nationwide are on Medicaid.
Many in the nursing home industry have voiced support of the bill, but some say the industry has already addressed the issue of Medicaid patient evictions.