The Office of the Inspector General (OIG) found that Florida did not ensure that nursing facilities always reported potential abuse or neglect of Medicaid beneficiaries transferred from nursing facilities to hospital emergency departments. Also, it could not be determined whether the state of Florida compiled with Federal requirements for assigning a priority level, initiating onsite surveys, and recording allegations of potential abuse or neglect.
In addition, Florida’s incident report program may not have been effective in accomplishing the program’s goals and objectives. Specifically, Florida lacked written policies and procedures for processing incident reports, had inadequate intake staffing, had inadequate incident report processing, lacked written policies and procedures for managing late incident report filings, and lacked written policies and procedures for managing APS abuse and neglect investigation notifications.
The OIG reviewed a sample of 104 hospital claims for emergency department visits in calendar year 2016 made by Medicaid nursing facility residents for which the medical diagnosis code indicated potential abuse or neglect of the resident. The OIG also reviewed whether nursing facilities properly reported and whether Florida properly assessed, prioritized, recorded, and initiated surveys of allegations or incidents of potential abuse or neglect. Finally, the OIG reviewed Florida’s policies and procedures related to its complaint and incident program.
The objective of the audit was to determine whether Florida:
- Ensured that nursing facilities reported potential abuse or neglect of Medicaid beneficiaries transferred from nursing facilities to hospital emergency departments.
- Compiled with Federal requirements for assigning a priority level, initiating onsite surveys, and recording allegations of potential abuse and neglect.
- Operated its incident report program effectively.
After completion of the audit, OIG recommends that Florida:
- Work with the Centers for Medicare & Medicaid Services (CMS) to provide clear guidance to nursing facilities regarding what constitutes a reportable incident.
- Establish procedures to require assessment start and end dates and priority level assignments.
- Establish and implement written policies and procedures for incident report processing.
The OIG made further recommendations to improve the effectiveness of the Florida complaint and incident report process. In the written comments regarding the OIG draft report, the Department of Health and Quality Assurance (DHQA) commented on two of the three findings and concurred or partially concurred with six of the seven recommendations. DHQA described actions taken and processes modified or implemented to address the findings and recommendations. However, DHQA did not concur with the recommendations to take specific steps to improve its intake process.
Issue:
Reporting abuse, neglect and exploitation is mandatory for all nursing facilities. It is crucial that each nursing facility has a process in place for the reporting of abuse, neglect, and exploitation of residents. The identification, reporting, and investigation of all types of abuse must be clearly established, with all staff members knowing what their role is when identifying, reporting, and investigating abuse. Chapter 7 Residents Rights in the Med-Net Corporate Compliance and Ethics Manual includes Policy RR 1.1 Freedom from Abuse, Neglect, and Exploitation that can be used when providing staff education.
Discussion Points:
- Review your policies and procedures on abuse, neglect, and exploitation. Review your policy and procedure on identifying, reporting, and investigating abuse. Update your policies as needed.
- Train all staff on their responsibilities related to identifying, reporting, and investigating resident abuse. Include this training in new employee orientation, and provide refresher education annually and as needed throughout the year. Document that this training occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure that staff are knowledgeable in how to identify, report, and investigate suspicions of abuse, neglect, and exploitation.
