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

Nebraska did not always verify nursing homes' correction of deficiencies identified during surveys in calendar year (CY) 2016 in accordance with Federal requirements. We estimated that Nebraska did not obtain or maintain the nursing homes' evidence verifying correction of deficiencies for 866'(92'percent) of the 938 deficiencies identified during surveys in CY 2016.

Nebraska's practice, in cases of less serious deficiencies that did not require followup surveys, was to accept the nursing homes' plans of correction without requiring any additional documentation. For more serious deficiencies that did require followup surveys, Nebraska did not maintain sufficient documentation to show that it had verified the correction of these deficiencies. (Federal requirements specify that State agencies obtain evidence of correction or conduct followup surveys to verify that nursing homes are in substantial compliance with Federal participation requirements.) Evidence of correction that may have been on record for more serious deficiencies was stored in electronic files that could not be opened or were missing.

We recommended that Nebraska revise its policies to require nursing homes to include evidence of correction with all submitted correction plans for deficiencies at or above the level of seriousness designated in Federal requirements and ensure that this evidence is retained by the State. We also recommended that Nebraska maintain accessibility of, and the ability to read, survey data documentation in accordance with changes in technology.

Nebraska described corrective actions that it said it had implemented. Nebraska asserted that for less serious deficiencies, acceptance of a nursing home's plan of correction constituted acceptable evidence of correction; Nebraska also pointed to an operational dysfunction in the Centers for Medicare & Medicaid Services' (CMS) electronic system. Regarding the more serious deficiencies, Nebraska disputed that both it and we were unable to open the electronic files containing evidence of correction. Nebraska said that its staff accessed CMS's secure software and provided the information to us.

We maintain that our findings and recommendations remain valid. A nursing home's submission of a plan of correction does not relieve a State of its responsibility to verify that previously identified deficiencies have been corrected. In addition, the evidence of correction that Nebraska provided was limited and, contrary to the State's own procedures, came from only one information source.p.