HCAM Leads Efforts on Regulatory Reform Legislation (SNF)

House Bill 5609 was introduced Tuesday, December 7 by Representative Bronna Kahle and referred to the House Health Policy Committee. This legislation is the culmination of efforts between HCAM and the Department of Licensing and Regulatory Affairs (LARA) to address the inefficiencies of the survey process. In May of this year, at the request of HCAM, LARA convened a workgroup consisting of providers and surveyors to identify areas of concern and corresponding solutions. The resulting recommendations are focused on ensuring a fairer, timelier and more consistent survey process across the state. These recommendations are reflected in the bill.

The major provisions of the bill include:

• Include a quality assurance (QA) monitor in each of the survey teams. The purpose of this position would be to ensure that the surveyors are conducting the survey in a timely, professional, and accurate manner. They would also ensure that the surveys throughout the state would be consistent in their application of regulations and in their process. The bill also creates a quality improvement officer position with the bureau, which would oversee the monitors. The findings of the monitors/QI officer would be presented to the advisory workgroup.
• Offer options for LARA to contract with a qualified entity to review priority 3 and 4 facility reported incidents. Through the workgroups, it was determined, and LARA agreed, that the volume of FRIs often overwhelms the department and contributes to delays in the survey process. Allowing LARA to delegate review of lower level FRIs (84% of which do not involve harm and do not result in a finding of noncompliance) will allow surveyors to focus on ensuring timeliness of the survey process.
• Require the reporting of FRIs by county to be shared with the department and providers to trend the pervasiveness of FRIs by region. Again, the goal is to reduce the number of FRIs as Michigan is a national outlier.
• Direct CMP monies back to the paying facilities to help address the issues that result in noncompliance. As fines have increased, it is important that they be directed to enhance resident care. Applying these funds to improve deficiencies identified by surveyors that led to the citation and fine would do just that.
• Require communication from surveyors upon entry, exit, and prior to issuing a citation of immediate jeopardy to ensure surveyors gather all necessary and pertinent information. Additionally, because of the severity of the immediate jeopardy citation, the language requires the surveyor to remain in the building until the situation is abated. The language additionally creates transparency of the survey process to help promote consistency and fairness, and so the facility understands how surveyors arrived to the citation, and therefore clarity on how the facility can fix the issue and come back into compliance as quickly as possible.
• Codify the new internal dispute resolution (IDR) process implemented by LARA. The bill language allows facilities to have access to these recommendations, which allows the facility to learn from the recommendations to improve quality. They also allow surveyors to improve their processes. The MPRO recommendations should be utilized by both providers and the state to improve resident care and outcomes.
• Direct the department to issue guidance on what is required to be reported by facilities, and lists the situations and circumstances that do not rise to the reporting requirement. The goal is to reduce unnecessary FRIs, avoid failure to report citations, and reduce the burden on LARA staff. This guidance will provide clarity on elopements, bruising, repeated statements from residents with mental health behaviors, and resident-to-resident incidents with no harm specifically.

Representative Kahle is the chair of the Health Policy Committee and has indicated a goal of early January for an initial hearing on the bill. You may find the bill and track its progress HERE.