Data driven modernization of the survey process

(a)

Review of State and contractor survey procedures

(1)

Medicare

Section 1819(g)(2)(A)(i) of the Social Security Act (42 U.S.C. 1395i–3(g)(2)(A)(i)) is amended— (A)by striking of before not to exceed in the second sentence; and (B)by striking each State's procedures for the scheduling and conduct of standard surveys to assure that the State and inserting the procedures of each State, or other contractor as chosen by the Secretary, for scheduling and conducting standard surveys to assure that the State, or other contractor,. (2)

Medicaid

Section 1919(g)(2)(A)(i) of the Social Security Act (42 U.S.C. 1396r(g)(2)(A)(i)) is amended— (A)by striking of before not to exceed in the second sentence; and (B)by striking each State's procedures for the scheduling and conduct of standard surveys to assure that the State and inserting the procedures of each State, or other contractor as chosen by the Secretary, for scheduling and conducting standard surveys to assure that the State, or other contractor,. (b)

Frequency of surveys of top tier and other facilities

(1)

Medicare

Section 1819(g)(2)(A)(iii) of the Social Security Act (42 U.S.C. 1395i–3(g)(2)(A)(iii)) is amended— (A)by striking subclause (I); (B)by redesignating subclause (II) as subclause (III); (C)in subclause (III), as so redesignated, by striking subclause (I) and inserting subclauses (I) and (II); and (D)by inserting before subclause (III), as so redesignated, the following subclauses:

(I)

Surveys of top tier facilities

Each skilled nursing facility in the top tier (as defined by the Secretary in regulations) shall be subject to a complete on-site standard survey not later than 36 months after the date of the previous standard survey of such facility conducted under this subparagraph. The statewide average interval between standard surveys of top tier skilled nursing facilities under this subclause shall not exceed 39 months. Such facilities will also be subject to quarterly off-site review of acuity-adjusted quality indicators (as identified by the Secretary). During any year in which a top tier skilled nursing facility does not receive a complete on-site standard survey, such facility will also be subject to an annual half-day on-site review of quality of life and safety issues. All necessary data in connection with such surveys shall be submitted to the Secretary by each such top tier skilled nursing facility at a time and in such a manner as determined by the Secretary. (II)

Surveys of other facilities

Skilled nursing facilities not identified in subclause (I) shall be subject to a complete standard on-site survey not later than 12 months after the date of the previous standard survey of such facility conducted under this subparagraph. The statewide average interval between standard surveys of such facilities shall not exceed 15 months. Such facilities also will be subject to quarterly off-site review of acuity-adjusted quality indicators (as identified by the Secretary). All necessary data in connection with such surveys shall be submitted to the Secretary by each such facility at a time and in such a manner as determined by the Secretary.

(2)

Medicaid

Section 1919(g)(2)(A)(iii) of the Social Security Act (42 U.S.C. 1396r(g)(2)(A)(iii)) is amended— (A)by striking subclause (I); (B)by redesignating subclause (II) as subclause (III); (C)in subclause (III), as so redesignated, by striking subclause (I) and inserting subclauses (I) and (II); and (D)by inserting before subclause (III), as so redesignated, the following subclauses:

(I)

Surveys of top tier facilities

Each nursing facility in the top tier (as defined by the Secretary in regulations) shall be subject to a complete on-site standard survey not later than 36 months after the date of the previous standard survey of such facility conducted under this subparagraph. The statewide average interval between standard surveys of top tier nursing facilities under this subclause shall not exceed 39 months. Such facilities will also be subject to quarterly off-site review of acuity-adjusted quality indicators (as identified by the Secretary). During any year in which a top tier nursing facility does not receive a complete on-site standard survey, such facility will also be subject to an annual half-day on-site review of quality of life and safety issues. All necessary data in connection with such surveys shall be submitted to the Secretary by each such top tier nursing facility at a time and in such a manner as determined by the Secretary. (II)

Surveys of other facilities

Nursing facilities not identified in subclause (I) shall be subject to a complete standard on-site survey not later than 12 months after the date of the previous standard survey of such facility conducted under this subparagraph. The statewide average interval between standard surveys of such facilities shall not exceed 15 months. Such facilities also will be subject to quarterly off-site review of acuity-adjusted quality indicators (as identified by the Secretary). All necessary data in connection with such surveys shall be submitted to the Secretary by each such facility at a time and in such a manner as determined by the Secretary.

(c)

Change in effective dates

(1)

Medicare

Section 1819(g)(2)(C) of the Social Security Act (42 U.S.C. 1395i–3(g)(2)(C)) is amended— (A)in clause (i)— (i)by inserting (I) before based on a protocol; and (ii)by striking , and and inserting

; or(II)with respect to surveys conducted on or after the last day of the 24-month period beginning on the date of the enactment of the Enhancing Quality through Survey System Improvements Act of 2010, based on a revision of protocol under subclause (I) that has been tested and validated not later than such last day; and

; and

(B)in clause (ii), by striking such date and inserting January 1, 1990, or, with respect to surveys conducted on or after the last day of the 24-month period beginning on the date of the enactment of the Enhancing Quality through Survey System Improvements Act of 2010, by such last day.. (2)

Medicaid

Section 1919(g)(2)(C) of the Social Security Act (42 U.S.C. 1396r(g)(2)(C)) is amended— (A)in clause (i)— (i)by inserting (I) before based on a protocol; and (ii)by striking , and and inserting

; and

Consistency of surveys

(1)

Medicare

Section 1819(g)(2) of the Social Security Act (42 U.S.C. 1395i–3(g)(2)) is amended by striking subparagraph (D) and inserting the following:

(D)

Consistency of surveys

(i)

In general

Each State shall implement programs to measure and reduce inconsistency in the application of survey results (including the results of both health surveys and life safety surveys) among surveyors. (ii)

Secretary provides oversight

The Secretary shall take such actions as necessary to assure that there is consistent application, both within States and across States, of the survey process under this subsection (including the process for both health surveys and life safety surveys). (iii)

Appeals

The Secretary will assure that there is a fair and timely appeals process for surveys under this subsection (including both health surveys and life safety surveys) in which each State office and regional office provides a timely resolution of disputes. (iv)

Report

The Secretary shall report to the Congress annually, by October 30, on the actions taken to ensure the consistency of the survey process within and across states. Such report shall include data that assesses the consistency of the survey process. Such report also shall provide a summary of the status of appeals process, including data that assesses the timeliness of the resolution of disputes.

(2)

Medicaid

Section 1919(g)(2) of the Social Security Act (42 U.S.C. 1396r(g)(2)) is amended by striking subparagraph (D) and inserting the following:

(D)

Consistency of surveys

(i)

In general

Secretary provides oversight

Appeals

Report

(e)

Circumstances for special surveys of compliance

(1)

Medicare

Section 1819(g)(3)(D) of the Social Security Act (42 U.S.C. 1395i–3(g)(3)(D)) is amended by striking subparagraph (D) and inserting the following: (A)By inserting (I) In general.— before Where the Secretary has and adjusting the indentation appropriately. (B)By adding at the end the following new subclause:

(II)

Circumstances for special surveys

The Secretary shall conduct a survey under subclause (I) of a skilled nursing facility if, with respect to such facility, any of the following events occurs: (aa)A complaint is made by a resident or family member of a resident of such facility. (bb)The skilled nursing facility self-reports a reportable incident to the State agency responsible for surveys and certifications under this subsection. (cc)A quarterly review of quality indicator data from such facility suggests a potential problem at such facility.

(2)

Medicaid

Section 1919(g)(3)(D) of the Social Security Act (42 U.S.C. 1396r(g)(3)(D)) is amended— (A)by inserting (I) In general.— before Where the Secretary has and adjusting the indentation appropriately; and (B)by adding at the end the following new subclause:

(II)

Circumstances for special surveys

The Secretary shall conduct a survey under subclause (I) of a nursing facility if, with respect to such facility, any of the following events occurs: (aa)A complaint is made by a resident or family member of a resident of such facility. (bb)The nursing facility self-reports a reportable incident to the State agency responsible for surveys and certifications under this subsection. (cc)A quarterly review of quality indicator data from such facility suggests a potential problem at such facility.

(f)

Notice to facilities and the public

(1)

Medicare

Section 1819(g)(5) of the Social Security Act (42 U.S.C. 1395i–3(g)(5)) is amended— (A)in subparagraph (A)(i), by striking statements of deficiencies and inserting reports of surveys under subparagraph (F); and (B)by adding at the end the following new subparagraph:

(F)

Notice to facility

A written report of the survey must be given to the skilled nursing facility within 15 calendar days following the date the survey team exited the facility. The report of the survey must include all the positive aspects of care and facility life as well as the aspects of care that may need improvement.

(2)

Medicaid

Section 1919(g)(5) of the Social Security Act (42 U.S.C. 1396r(g)(5)) is amended— (A)in subparagraph (A)(i), by striking statements of deficiencies and inserting reports of surveys under subparagraph (F); and (B)by adding at the end the following new subparagraph:

(F)

Notice to facility

A written report of the survey must be given to the nursing facility within 15 calendar days following the date the survey team exited the facility. The report of the survey must include all the positive aspects of care and facility life as well as the aspects of care that may need improvement.

(g)

Treatment of funds collected from civil monetary penalties

(1)

Medicare

Section 1819(h)(2)(A) of the Social Security Act (42 U.S.C. 1395i–3(h)(2)(A)) is amended by adding at the end (in the flush matter following clause (ii)) the following sentence: Notwithstanding the previous sentence, any funds collected by a State as a result of the imposition of such a penalty (or as a result of the imposition by the State of a civil money penalty for activities described in subsections (b)(3)(B)(ii)(I), (b)(3)(B)(ii)(II), or (g)(2)(A)(i)) shall be used for development of acuity adjusters that will provide more accurate information to the public, skilled nursing facilities, and the residents of such facilities, about the quality of care that is provided by each such facility.. (2)

Medicaid

Section 1919(h)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1396r(h)(2)(A)(ii)) is amended by adding at the end (in the flush matter following clause (ii)) the following sentence: Notwithstanding the previous sentence, any funds collected by a State as a result of the imposition of such a penalty (or as a result of the imposition by the State of a civil money penalty for activities described in subsections (b)(3)(B)(ii)(I), (b)(3)(B)(ii)(II), or (g)(2)(A)(i)) shall be used for development of acuity adjusters that will provide more accurate information to the public, nursing facilities, and the residents of such facilities, about the quality of care that is provided by each such facility..