Officials: Nursing-home rules to stay

  1. Health and Human Services had considered easing up on homes with a history of good care.

    By Laura Meckler

    WASHINGTON - White House officials said yesterday that they had rejected proposals at the Department of Health and Human Services to soften government regulation of certain nursing homes.

    The idea was to lessen the frequency of inspections of nursing homes that have consistently followed the law while increasing inspections at homes with a history of problems. Inspecting all homes once a year, no matter what their quality, was "nutty," a top HHS official said earlier this year.

    Yesterday, White House spokesman Ari Fleischer said the idea had been considered and rejected "out of hand."

    Fleischer said President Bush planned to outline a nursing-home initiative this fall.

    "We're going to beef up and strengthen nursing-home protections," he said. "We're working to strengthen accountability."

    The proposal to change the frequency of inspections was first reported yesterday by the New York Times. An HHS spokesman, Bill Pierce, confirmed the essence of the plan late Thursday.

    But yesterday morning, administration officials at the White House and HHS said nothing like that was being considered. Pierce said he had based his comments on outdated information and had been told the plan was rejected.

    It is unclear how far the idea got within the administration.

    Fleischer said the idea was presented and rejected at a White House meeting with HHS officials more than two weeks ago. But Tom Scully, the top HHS official at the Center for Medicare and Medicaid Services, said that it was never a serious proposal and that he knew of no one who proposed it to White House officials.

    Scully, who called mandatory annual inspections "nutty," said the heart of the "nursing-home quality initiative" involved collecting better data on the quality of care at each home to help consumers make smart choices.

    Once those data are available and reliable, he said, they could be used to prioritize inspections.

    "If you come up with widely accepted quality measurements, you probably would at some point consider using them to better target your resources," Scully said.

    In a letter this week, Scully suggested it was an idea he was actively considering.

    "I feel a responsibility to explore balancing the work that needs to be done with the resources available for us to do it - while at the same time protecting the health and safety of nursing home residents," he wrote Sen. Charles E. Grassley of Iowa, the top Republican on the Finance Committee, which oversees Medicare and Medicaid.

    Nursing homes say federal regulations are too onerous, but easing them is a dicey political proposition. Consumer advocates warn that a nursing home that is good one day can turn unsafe the next with a change in management or patients.

    Federal law requires inspections once a year for nursing homes that receive payments from Medicaid or Medicare, with no more than 15 months between inspections.

    The administration was considering changes that would increase the average time between inspections to two or three years, according to documents cited by the Times.

    The paper also said the administration wanted Congress to reconsider a law that requires the government to stop payments to nursing homes that fail to comply with federal health and safety standards within six months after an inspection.

    Think CFM&M caught tons of flack when they floated this idea.Karen
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