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Consumer Voice’s “Comments” to Proposed Medicare/Medicaid Rule Changes

Our attorneys, along with many resident advocacy organizations, frequently explain that systematic changes that improve the lives of all nursing home residents often center on a government agency: The Center for Medicare and Medicaid Services (CMS). That is because a large swath of nursing home care is actually paid for by these programs. Medicare covers certain rehabilitative stays while Medicaid provides the bulk of payments for traditional long-term nursing home needs.

Providers of this care, in order to qualify for continued enrollment in CMS programs, must meet their demands. Sure, the nursing homes can try to get money only from residents who pay out of their own pocket or have long-term care insurance–but those individuals are few and far between. For that reason, most facilities can only operate with CMS support.

Therefore, all efforts to CMS rules, regulations, and policies which may touch on nursing home care is important to monitor. Luckily we have organizations like the Consumer Voice to do just that. In fact, recently the Consumer Voice submitted comments to CMS with regard to proposed changes related to CMS survey, certification, and enforcement procedures.

A full letter to the office spelling out those comments can be found here.

Consumer Voice Comments
The specific details of the proposed changes are somewhat nuanced. However, all those who care about nursing home residents receiving proper care can
glean a few important principles from the arguments set forth in the letter.

For example, it is pointed out that “delivery of quality care is the responsibility of the government and should not be transferred to a private non-regulatory entity that is accountable to its clients–healthcare providers– and not to the public.” This is the same principle that underlies the discrepancy between care quality at non-profit and for-profit facilities. While money pressures will always plays some role in these services, the goal should be to minimize the distortion pressures.

In this particular case, the issue is the merit of “accreditation organizations” which seemingly work to ensure proper standards for “accreditation” of nursing home. The problem is that the accreditation organizations are private entities that receive funds directly from the nursing homes themselves. Therefore, in every sense the nursing homes are the clients of the organization. It is illogical for the organization to rely on the very facilities it may need to judge harshly for its financial sustainability
With these letter, the Consumer Voice urged CMS to continued denying this “deemed status” option to long-term care facilities like nursing homes. The conflict of interest is obvious and the best interests of residents are not met by changing the rules.

The remainder of the letter spells out more clearly the Consumer Voice’s arguments against “deemed status.” In addition, there is discussion of oversight of national accreditation organizations in general. Those interested in the more technical issues should read the entire comments.

For our part, our legal teams is acutely aware of the consequences for improper oversight of long-term care facilities that leads to substandard services and ultimately, injured residents. We applaud the work of organizations like Consumer Voice which ensure the rights of actual residents are heard every step of the way.

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