Care homes become ‘high risk’, owners must be fingerprinted as part of proposal

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Nursing home owners could face increased background check requirements under a proposal containing more than 1,000 pages in a huge new proposed doctor compensation rule released on Thursday.

The Centers for Medicare & Medicaid Services said it wants to improve fingerprinting and other screening requirements amid recent government surveillance reports of patient abuse and health insurance fraud authorized by qualified nursing owners. The proposed rule would move skilled nursing facilities from a “limited risk” screening category to a “high” level.

“Given the prevalence of recent unacceptable behaviors by nursing home supervisors and OIG and GAO documented cases of abuse of nursing home beneficiaries, we propose to…relocate SNFs initially enrolled in the high level of categorical selection; revalidation of SNFs would be subject to a moderate risk level review,” the proposal explains, referencing reports from the federal watchdog. “Requiring all SNF owners with 5% or more ownership to submit their fingerprints for a criminal background check would help us identify parties potentially at risk of fraud, waste or abuse and, with that, the threat of patient abuse.”

The agency stressed that the change “would help protect Medicare Trust Fund dollars and beneficiaries.” [and it] aligns with the Biden-Harris administration’s initiative to improve nursing home accountability.

In 10 pages of text, CMS described several examples of what it called financial malfeasance and beneficiary abuse by nursing homes to justify the change. They ranged from the provision of unnecessary services to allegations of misrepresentation and embezzlement.

“We believe that further screening of nursing home owners through our existing criminal background checks … can help detect potential criminal or abusive behavior in the nursing home before it begins,” says Rule.

“To illustrate, if an SNF owner is found guilty, through a fingerprint-based background check, of assault and battery, sexual assault or some other serious crime, this could raise significant concerns about whether this conduct will be repeated during owner oversight or facility management,” the agency wrote. “An SNF owner convicted of embezzlement may be more inclined to misappropriate SNF funds for personal use ( and away from funds otherwise intended for beneficiary care) than another landlord; he or she might also be more inclined to tolerate malfeasance in the nursing home or hire people with criminal records.

The agency already uses a fingerprint-based criminal background check system to detect past criminal behavior of owners of a few other types of high-risk services and supplies. They include home health agencies, durable medical supply providers, opioid treatment program providers, and diabetes prevention program providers.

ACOs among the points of attention

The 2,066-page Physician Fee Schedule 2023 also includes detailed language on redesigning accountable care organizations to make them more attractive and encourage broader participation.

The agency called proposed changes to its Medicare Shared Savings Program “some of the most significant reforms” since its formal inception in 2011. CMS wants to incorporate shared savings payments to select new ACOs from the program. shared Medicare savings that could be used for social needs of beneficiaries.

Traditional Medicare payments are generally not allowed to be used for such purposes, although they have helped spark consumer interest in Medicare Advantage plans.

CMS also proposed that smaller ACOs have more time to transition to downside risk, which it says could help increase participation in rural and underserved communities. The rule also includes a health equity adjustment to reward excellent care for underserved populations, including patients with dual eligibility. Finally, CMS offers benchmark adjustments to encourage more ACOs. This would reinforce the agency’s goal of transitioning all traditional Medicare beneficiaries into some type of accountable care program by 2030.

The proposed rule would also dramatically expand access to behavioral health services, cancer screening and dental care, especially in rural and underserved areas. The agency also proposed bundling some chronic pain management and treatment services into new monthly payments, improving patient access to comprehensive, team-based chronic pain treatment.

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