Kansas Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid

On the basis of our review of 100 sampled deficiencies, we determined that the Kansas Department of Aging and Disability Services, Survey, Certification and Credentialing Commission (State agency), did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year 2014 in accordance with Federal requirements. We estimated that the State agency did not obtain the nursing homes' evidence verifying correction of deficiencies in accordance with Federal requirements for 52 percent of the deficiencies identified during surveys in CY 2014. We also estimated that the State agency could not provide sufficient evidence that corrective actions had been taken for 13 percent of the deficiencies identified during those surveys. In addition, the State agency did not always conduct required standard surveys within 15 months of the previous standard surveys in CY 2014 in accordance with Federal requirements.

We recommended that the State agency (1) improve its practices for verifying nursing homes' correction of identified deficiencies, (2) update controls and policies and procedures to ensure that survey system data is protected against unauthorized or unintended modification or loss, and (3) develop and implement a correction plan to ensure that the interval between consecutive standard surveys does not exceed 15 months. The State agency agreed with our findings and described corrective actions that it had taken or planned to take.