The growing interest in assisted living oversight could change training and job descriptions
Assisted living providers that utilize Medicaid funds could soon be asked to provide significantly more documentation on employee/resident welfare, incident reporting and the delivery of services. A surge in reporting requirements would require new training programs at the very least and could significantly change the job tasks of assisted living administrators.
A report produced by the Government Accountability Office (GAO) outlined recommendations for the Centers for Medicare & Medicaid Services (CMS) to develop federal oversight for critical incidents in the assisted living sector, which has existed generally outside the realm of CMS regulation.
While states are required to monitor and report “deficiencies affecting beneficiary health and welfare for the most common program used to provide assisted living services,” the definition of a “deficiency” is not standardized across states, notes the GAO report, “Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare is Needed.” Since the reporting data is rarely exchanged with CMS, much of assisted living deficiency reporting is rendered into summary reports based on the state’s own definition of criteria. That may be changing soon.
After surveying all 50 states, the report discovered vast inconsistencies in what types of incidents assisted living providers considered “serious” or “critical,” leading to equally inconsistent approaches to incident monitoring. In 26 states, the state Medicaid agencies “could not report to GAO the number of critical incidents that occurred in assisted living facilities, citing reasons including the inability to track incidents by provider type (9 states), lack of a system to collect critical incidents (9 states), and lack of a system that could identify Medicaid beneficiaries (5 states),” the report summary notes.
The GAO outlines several recommendations to CMS, including:
- Establishing standard definitions across all states of what qualifies as a “critical” incident and how it should be monitored and reported
- Providing greater guidance on deficiency reporting for states that use home and community-based services (HBCS) waivers
- Instituting annual reporting requirements
In its responses to the GAO’s recommendations, CMS agreed to clarify requirements for state reporting of program deficiencies and to institute policies to ensure timely submission of data, and has assigned a 2018 workgroup to explore state health and welfare systems in greater depth.
HR: Staying Ahead of the Regs Curve
How can HR help keep assisted living organizations ahead of the shift toward greater regulation? Any increase in state reporting requirements will mean additional training in how to document, monitor and report deficiencies based on the new guidelines under development—and in how to reduce deficiencies through improvement programs. Explore training resources and budgets before the training is required. Proactive approaches to the reduction of workplace incidents also will keep the provider organization from playing catchup later.
Greater pressure will fall on site administrators to ensure compliance with state and federal rules, while consumer pressure will push organizations to reach for a competitive edge against national benchmarking. Depending on the staff mix, some sites may need to augment staff with greater expertise in regulatory compliance—a position that is common in skilled nursing sectors, but not in assisted living.
The home health and community-based services sector is a special wrinkle, so HR departments need to include training and education programs for those who deliver their services outside the central care center. HCBS services are still considered a bit of a gray area in the market, often tethered to another care level (such as home-based, post-discharge services from a SNF) yet greatly unregulated on their own. One of the GAO’s three recommendations to CMS was to look harder at this area. Depending on what definitions CMS develops for HCBS waivers, some providers that offer these services may have to implement new systems for capturing data, monitoring incidents and reporting to the state and federal agencies.
Partnering with administrators and encouraging an assessment of training needs can help. Since change starts with education, explore opportunities for key administrators to attend workshops or presentations; institute clear, concise training approaches; and determine whether adding employees with specific compliance skills would be a wise strategy.
