The Centers for Medicare & Medicaid Services’ (CMS) Quality Safety and Oversight Group (QSOG) provides oversight and ensures compliance for providers serving Medicare and Medicaid beneficiaries. State survey agencies support QSOG by conducting facility surveys to verify compliance with Conditions of Participation or Requirements for Participation, and they complete the certification process and investigate complaints from beneficiaries or their families. For what is sometimes referred to as the “survey and certification” process, state survey agencies are required to provide data and reports to CMS via the 10 Regional Offices. To assess how well the agencies perform their activities, CMS established a comprehensive set of standards called the State Performance Standards System (SPSS).
This project assists CMS in efforts to evaluate and redesign the SPSS to improve the oversight of provider certification processes and enforcement protocols of long-term care facilities (e.g., nursing homes). In turn, CMS hopes to improve provider compliance and health outcomes. Insight is identifying obstacles for the agencies in conducting facility surveys and implementing certification activities, evaluating the SPPS, developing and implementing recommendations, and identifying areas for future improvement so fewer deficiencies go uncited. Overall, the work has the following objectives:
- Evaluate the current SPSS through an analysis and modeling of existing data, including quality certification and oversight reports, long-term care minimum datasets, quality improvement and evaluation system data, and others.
- Lead stakeholder conversations to solicit feedback.
- Recruit and maintain a panel of subject matter experts consisting of physicians, administrators, nurses, healthcare surveyors, research analysts, and others with expertise in areas related to nursing home care and residents.
- Make recommendations on how to improve the SPSS program to better assess state performance.
- Pilot test changes to the system based on recommendations.
- Implement and support a new SPSS systems rollout through revised SPSS guidance, web-based learning sessions, and specialized technical support through three stages: (1) planning and preparation, lasting 4–6 months; (2) system-wide rollout, lasting 18–20 months; and (3) monitoring and evaluation, concurrent with the rollout.