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Government to make long term care a priority issue in 2005.

There could be a lot of long term care-related paperwork coming out of Capitol Hill in 2005, with the federal government announcing plans to examine more than a dozen major industry issues--including Medicare payments to long term care facilities, level of care in such places, and nursing home deficiency trends

The Washington, D.C.-based Department of Health and Human Services' Office of the Inspector General's annual Work Plan will mean the release of numerous industry-related reports, studies and expert analysis, according to Ben St. John, an OIG spokesperson.

Industry-related items in the 92page report include:

* Long term care hospital payments. OIG is reviewing the appropriateness of early discharges from long term care facilities to home, and subsequent payments to these facilities. This study should be released in 2005.

* Level of care in long term care hospitals. The office is currently reviewing whether Medicare beneficiaries require acute-level services or could be cared for in less-expensive skilled nursing facilities. This study should also be released in 2005.

* Medicare beneficiaries' access to skilled nursing facilities. Past studies by OIG in 1999, 2000 and 2001 found that most Medicare beneficiaries were able to get the skilled nursing services they needed, but some with certain medical conditions experienced delays. The office plans to update studies in this area during 2005.

* Nursing home deficiency trends. In another update, OIG wants to take a new look at the extent of survey and certification deficiencies in nursing homes. A 2002 report found that the proportion of nursing homes cited for deficiencies, the total number of deficiencies, and key categories of deficiencies related to quality of care had all increased since 1998.

* Enforcement actions against nursing homes. The office is examining the effectiveness of state and Centers for Medicare & Medicaid Services (CMS) actions against noncompliant nursing homes. A primary focus will be to determine if states are appropriately referring nursing home enforcement cases to CMS.

* Nursing home residents' rights. OIG plans to assess the extent to which nursing home residents and their families are aware of their rights.

* State compliance with complaint investigation guidelines. OIG is currently assessing how efficient states are in following CMS guidelines, and their own, in investigating abuse complaints.

* Reimbursement to assisted living facilities. The office is currently reviewing whether certain states were improperly reimbursed for services provided to residents of assisted living facilities, and the impact this may have had on the Medicaid program.

* Services for mentally ill nursing home residents. OIG plans to assess preadmission screening programs for Medicaid nursing facilities that accept seriously mentally ill or retarded residents age 22 to 64. A 2001 report found that most such programs did not meet federal requirements. The office hopes to release this report in 2006.

The federal government developed an Office of the Inspector General to oversee operations in each of departments, including Health and Human Services, the Department of Labor and Social Security. The agency's mission is to minimize fraud, waste and abuse in government programs, according to the OIG Web site.

While OIG usually completes most of the studies it launches each year, don't hold your breath for immediate changes in reimbursement rates or working standards, according to St. John.

"These are initiatives we intend to undertake during the course of the fiscal year," St. John said. "But other events may occur which may cause us to redirect our resources. Congress may want a specific study, or we may determine a particular area that needs to be addressed."

Any reports that are produced will be available at www.oig.hhs.gov shortly after release, St. John said.
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Title Annotation:Capital Beat
Author:Naditz, Alan
Publication:Contemporary Long Term Care
Geographic Code:1USA
Date:Nov 1, 2004
Words:597
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