United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1999-11-04 monographic deposited born digital 49 p. GA 1.13:HEHS-00-6 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-6 P0b002ee18037f955 f:he00006 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-00-6 machine generated eng fdlp REPORT GAOREPORTS-HEHS-00-6 HEHS-00-6 Elder care Elderly persons Nursing homes State programs Safety standards Sanctions Surveys Noncompliance Federal/state relations Negligence Medicaid Program Medicare Program HCFA State Agency Quality Improvement Program Letter Report HEHS Pursuant to a congressional request, GAO provided information on the Health Care Financing Administration's (HCFA) oversight programs of state agencies' nursing home survey process, focusing on the: (1) effectiveness of HCFA's approaches to assessing state agency performance; (2) extent to which HCFA's regional offices vary in their application of these approaches; and (3) the corrective actions available to HCFA when it identifies poor state agency performance.<p/>GAO noted that: (1) since last year, HCFA has undertaken a series of initiatives intended to address quality problems facing the nation's nursing home residents, including redesigning its program for overseeing state agencies that survey nursing homes to ensure quality care; (2) the objective of HCFA's oversight program is to evaluate the adequacy of each state agency's performance in ensuring quality care in nursing homes, but the mechanisms it has created to do so are limited in their scope and effectiveness; (3) HCFA's oversight mechanisms are not applied consistently across each of its 10 regional offices; (4) HCFA does not have sufficient, consistent, and reliable data to evaluate the effectiveness of state agency performance or the success of its recent initiatives to improve nursing home care; (5) given the wide range in the frequencies with which states identify serious deficiencies, HCFA cannot be certain whether some states are failing to identify serious deficiencies that harm nursing home residents; (6) HCFA does not have an adequate array of effective sanctions to encourage a state agency to correct serious or widespread problems with its survey process; (7) HCFA's primary mechanism to monitor state survey performance stems from its statutory requirement to survey annually at least 5 percent of the nation's 17,000 nursing homes that states have certified as eligible for Medicare or Medicaid funds; (8) but HCFA's approach to these federal monitoring surveys does not produce sufficient information to assess the adequacy of state agency performance; (9) to fulfill its 5 percent monitoring mandate, HCFA makes negligible use of its most effective technique--an independent survey done by HCFA surveyors following completion of a state's survey--for assessing state agencies' abilities to identify serious deficiencies in nursing homes; (10) a second HCFA oversight mechanism also has significant shortcomings; (11) about 3 years ago, HCFA implemented the State Agency Quality Improvement Program (SAQIP), a program under which the state agency does a self-assessment to inform HCFA, at least once a year, whether the state is in compliance with seven standard requirements; and (12) SAQIP is limited as an oversight program, however, because HCFA: (a) does not independently validate the information that the states provide, so it is uncertain whether all serious problems are identified or whether identified problems are being corrected; and (b) has no policy regarding consequences for states that do not comply. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-6/html/GAOREPORTS-HEHS-00-6.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-00-6/pdf/GAOREPORTS-HEHS-00-6.pdf GAO/HEHS-00-6 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-00-6 Letter Report GAO/HEHS-00-6; Nursing Home Care: Enhanced HCFA Oversight of State; Elder care Elderly persons Nursing homes State programs Safety standards Sanctions Surveys Noncompliance Federal/state relations Negligence Medicaid Program Medicare Program HCFA State Agency Quality Improvement Program