​In a recent memo, the Centers for Medicare & Medicaid Services (CMS) said it is strengthening the system it uses to hold inspectors accountable under the State Performance Standards System (SPSS) for examining compliance with federal regulations by skilled nursing facilities (SNFs).

CMS said State Survey Agencies (SSAs), which inspect SNFs on a regular basis, will see changes in how the agency oversees their work, including through updated SPSS assessment tools and a more rigorous and rapid analysis of SSA performance to ensure inspections are timely and accurate.

“This includes new performance measures and stricter monitoring to ensure inspections are done in a fair, accurate, and timely manner; ensuring patient safety; and ensuring that enforcement actions, like civil money penalties, are applied consistently,” CMS said.

CMS Administrator Seema Verma said after careful study of state inspector performance, CMS is acting to increase oversight of inspectors and ensure states are conducting thorough and appropriate inspections.

“Our action delivers on the ‘Strengthening Oversight’ pillar of our five-part approach to ensuring safety and quality in nursing homes,” she said. “By holding inspectors accountable for conducting timely and consistent inspections, we’re holding nursing homes accountable for providing safe, high-quality care—helping ensure safe nursing home environments.”

In response, David Gifford, MD, senior vice president for quality and regulatory affairs, American Health Care Association (AHCA), said, “We are glad to see CMS work to improve the State Survey Agency oversight process; however, inspectors should be held to the same standards on thoroughness, completeness, and timeliness as providers. There should be more emphasis placed on the timeliness of survey inspections and follow-up visits, as this greatly affects providers’ timelines to prevent citations and fines.”

He added that AHCA encourages CMS to look at how to reduce the enormous variation in how states and regional offices interpret regulations and enforce them. “The transparency CMS has adopted with sharing information has brought this variation to light, but more can be done,” he said.

The specific changes to the SPSS include:

-          Increased monitoring through new metrics that are reviewed more frequently to ensure SSAs are conducting surveys in a timely manner;

-          New “State Performance Indicators” that will be reviewed quarterly to help identify potential issues with respect to SSA performance, helping CMS address problems before they worsen. CMS historically had examined each state’s performance on a set of longstanding measures after the close of the fiscal year. But, the new Performance Indicators include metrics to provide information related to citation rates and the timeliness of complaint investigations to allow for quick mitigation of issues;

-          Holding SSAs accountable for correctly handling cases in which health and safety are in immediate jeopardy. CMS said this step follows previous guidance to help SSAs identify and cite situations threatening immediate harm encountered during inspections;

-          Also, considering increased system flexibility for CMS to add state-specific measures to help CMS target resources to poor-performing SSAs; and

-          Better access for SSAs to centralized CMS data to avoid redundant or duplicative data reporting and unnecessary administrative burden on SSAs, helping them focus on their work to inspect SNFs for compliance.