New Regs To Address Quality

February 29, 2008
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LANSING — A state commission is expected to consider in March whether to approve a new set of regulations aimed at preventing sub-par nursing homes from building or expanding in Michigan.

The regulations, developed as part of the Michigan Department of Community Health’s first review of Certificate of Need nursing home standards in years, would demand that certain homes show that they have not been subject to a list of eight sanctions or citations related to patient care. Michigan is one of 36 states with CON laws.

“I think it would be pretty difficult to have an objection to including quality measures in state regulations,” said Irma Lopez, section manager in health policy for the MDCH.

A committee consisting of stakeholders in the long-term care industry spent a year reviewing nursing home standards, Lopez said. The members first presented the quality measures last fall, but spent several more months discussing them after concerns were raised. The MDCH’s Certificate of Need Commission is expected to vote in March, then send the regulations to a joint legislative committee, which has 45 days to review them. If the legislative committee takes no action, the regulations would go into effect, she said.

The criteria would come into play during comparative reviews, which look at competing applications for the same nursing home beds, said Lody Zwarensteyn, executive director of the Alliance for Health, which reviews applications from 13 counties in West Michigan. The criteria would be considered not only for the nursing home making the application, but also for homes under the same ownership, even if they are out of state. If a chain owns 10 or fewer homes, it must show that not more than one of its facilities is under sanction or citation; if a chain owns more than 10, no more than 14 percent of its facilities may fall under the criteria.

The new regulations want to know:

  •  Whether a state has revoked the nursing home’s license, reduced its capacity under the license, or taken it into receivership in the previous three years under the same ownership.

  • If the home has filed for bankruptcy within the previous three years.

  • Whether a termination of a medical assistance provider agreement has been initiated in another state.

  • Whether citations have exceeded twice the state average in two consecutive surveys.

  • If the facility is on the Special Focus Facility list, which targets homes with repeated, long-standing problems.

  • Whether the nursing home is in debt to the state of Michigan for the quality assurance assessment program or civil monetary penalties.

  • If the nursing home has had state or federal violations related to insufficient staffing within the previous three years.

  • Whether the home has incurred repeated citations for harm or substandard quality of care.

“I think the important thing to keep in mind is that the purpose of certificate of need is to assure that health services in Michigan are accessible, are of a quality level, and that they are cost-effective,” Lopez added.

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