Analysis of Proposed New Standards for Nursing Homes Participating in Medicare and Medicaid

GAO analyzed the impact of changes in nursing home quality of care standards included in a regulation proposed by the Department of Health and Human Services (HHS). This regulation applies to nursing homes which participate in Medicare and Medicaid programs. The two types of nursing homes which are affected by these changes are: (1) skilled nursing facilities, which provide covered care to Medicare and Medicaid patients; and (2) intermediate care facilities, which provide a slightly lower level of care and participate only in the Medicaid program administered by the States. Intermediate care facilities for the mentally retarded are not affected by the proposed changes.

The objectives of the new regulations include the elevation of patients' rights, the introduction of a patient care management system aimed at the care of the whole person, and the upgrading of the qualifications of key supervisors employed by the facilities. The new regulations should establish requirements for supervision of physician extenders and clearly state which functions are the patients' responsibility in respect to self-administration of medication. An industry estimate of the costs of compliance with the new regulations for facilities are approximately seven times the costs of compliance estimated by HHS. GAO was unable to determine which estimate was more realistic. Nursing home compliance with existing standards and individual requirements comprising these standards has been spotty. Many facilities are not complying with requirements which will be the key components of the proposed patient care management system. GAO has reservations about whether the regulations upgrading the quality of supervisory employees will have the desired impact in reducing noncompliance. There is a need for adequate oversight and enforcement of the regulations at Federal and State levels.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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