Public outcry and ambiguous policy proposals helped derail South Dakota's request for federal permission to implement a continuous quality improvement (CQI) approach to nursing facility oversight.
In July, South Dakota health officials received word that the Health Care Financing Administration (HCFA) had rejected the state's controversial HCFA Section 1115 waiver proposal, which would have essentially replaced current federally mandated survey and enforcement activities with a new state-designed inspection system driven by customer satisfaction surveys and resident-specific data from the Minimum Data Set (MDS) database.
In a letter announcing HCFA's decision, Administrator Bruce Vladeck made it clear that the agency "will not authorize any waiver of regulation which alters in any way the survey, certification, or enforcement process as described by both the State Operations Manual and pertinent regulation."
The ill-fated waiver request called for frequent resident surveys and monthly reviews of 30 MDS-based clinical indicators (i.e., use of physical restraints, frequency of unexplained weight loss, rates of untreated depression) as the primary oversight mechanisms. State surveyors would have been assigned to specific facilities as de facto members of the facility's quality assurance teams, while at the same time bearing responsibility for monitoring compliance with federal health and safety standards.
Consumer advocacy groups, led by the National Citizens Coalition for Nursing Home Reform (NCCNHR), had urged rejection of the plan on several grounds. First, NCCNHR noted, the waiver request described only a few specific triggers for writing of deficiency citations. Second, it did not contain clearly stated provisions for public access to survey and quality indicator data. Moreover, NCCNHR said, surveyors would have faced an inherent conflict of interest in their dual roles as oversight authorities and facility-based quality assurance consultants; this would "compromise surveyors' ability to objectively review conditions in their assigned facility, to cite deficiencies when warranted, and to impose remedies for noncompliance."
The American Health Care Association, which helped draft the proposal through its South Dakota affiliate, contends that a CQI approach to nursing home oversight is necessary to curb "yo-yo" compliance and promote lasting quality improvements.
Last month, Nebraska health officials held a hearing on a proposed Medicaid rule change that would limit dispensing fees to one per drug per month to pharmacies that serve nursing facilities or operate unit dose systems.
The proposed policy shift also would eliminate current rules that prohibit application of prior authorization requirements to new drug products for at least six months following Food and Drug Administration approval.
Under a new California law recently signed by Gov. Pete Wilson (R), pharmacists and other suppliers of dialysis drugs and equipment who meet specified state criteria are now permitted to distribute dangerous drugs and devices directly to dialysis patients in accordance with regulations adopted by the board of pharmacy. Previously, direct distribution provisions had applied only to hemodialysis services.
The new law also requires home dialysis patients receiving dangerous
drugs and supplies to complete a course of training at a renal
dialysis center.
HCFA Managed Care Marketing GuidelinesIn a move to rein in deceptive marketing practices by managed care plans eager to sign up new Medicaid enrollees, the Office of Managed Care of the Health Care Financing Administration recently issued the following guidelines for states that allow direct marketing to Medicaid-eligible populations:
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