REGULATORY

More oversight of nursing home staffing urged

The Office of the Inspector General (OIG) is recommending that the Centers for Medicare and Medicaid Services (CMS) strengthen its oversight of nursing home staffing by enhancing how it uses Payroll-Based Journal (PBJ) data.

The OIG urges more oversight by the federal agency to flag all nursing homes that provide fewer than the federally required 8 hours of registered nurse (RN) care per day and to supply states with more detailed staffing data.

Nursing home industry advocates say that government investment in staffing rather than scrutiny is the better solution to address staffing concerns.

CMS is not fully embracing all of OIG recommendations.

Due to “limited resources,” CMS has had to make choices – and currently flags the most at-risk nursing homes for survey agencies.

COMPLIANCE

Updated enforcement rules are driving significant shifts on how nursing homes approach compliance

Key Regulatory Changes Influencing Compliance

1. Dual Civil Monetary Penalties (CMPs)
CMS now permits simultaneous per-day and per-instance penalties (up to $10,000 each) for violations, a departure from previous restrictions. This creates heightened financial risks for facilities with recurring or severe deficiencies.

Strategy Shift: Facilities must prioritize correcting deficiencies swiftly to avoid escalating penalties. Proactive measures like mock surveys and root-cause analyses for repeat issues are critical.

2. Stricter Oversight of Low-Performing Facilities

CMS is expanding its Special Focus Facilities (SFF) program and enforcing more frequent inspections for underperforming nursing homes. Facilities with chronic staffing shortages or infection-control lapses face heightened scrutiny.

Strategy Shift: Implement real-time compliance tracking systems and preemptively address high-risk areas (e.g., staffing ratios, infection control) to avoid SFF designation.

3. Updated Surveyor Guidance
Revised Appendix PP of the State Operations Manual (effective March 2025) mandates stricter evaluation of:

• Admission/transfer/discharge practices (e.g., prohibitions on third-party payment guarantees)
• Psychotropic medication use and infection control

Strategy Shift: Update policies to align with clarified regulations and train staff on documentation standards to avoid citations.

4. OIG Compliance Program Guidance
The OIG’s 2024 Nursing Facility ICPG emphasizes seven core compliance elements, including risk assessments, staff education, and auditing. Facilities must now integrate social determinants of health (SDOH) data into quality reporting.

Strategy Shift: Develop role-specific training programs and establish cross-departmental compliance teams to address SDOH and billing risk.

PERFORMANCE METRICS

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