LeadingAge Michigan SNF Regulatory Day State Licensure & Federal Certification Update Bureau of Community & Health Systems (BCHS) Larry Horvath, Director
Regulatory Oversight Bureau of Community & Health Systems (BCHS) - Effective July 6, 2015 State Licensing Health Facilities & Agencies (including Homes for the Aged) Life Safety Code Inspections of Long Term Care Facilities Substance Use Disorder Programs Child Care Homes & Centers Adult Foster Care Homes Federal Certification of Providers and Suppliers on Behalf of the Centers for Medicare and Medicaid Services (CMS) Plan Review/Construction Permits for State Licensed Health Facilities Workforce Background Checks Nurse Aide Training Program/Nurse Aide Registry (February 1, 2016)
BCHS Organizational Overview Larry Horvath Bureau Director Steve Gobbo Deputy Bureau Director Mark Jansen, Director Child Care Licensing Division Jay Calewarts, Director Adult Foster Care & Camps Division Teri Dyke, Director Health Facility Licensing, Permits, and Support Division Michelle Roepke, Director Federal Survey & Certification Division State Licensed Child Care Group Homes/Centers State Licensed Adult Foster Care Homes Adult Foster Care/Child Camps Homes for the Aged State Licensed Freestanding Surgical Outpatient Facilities Hospice Agencies & Residences Hospitals Nursing Homes Substance Use Disorder Programs Other Functions Complaint Intake Construction Permits Nurse Aide Training Program Nurse Aide Registry FOIA Federal Certification Ambulatory Surgical Centers Clinical Laboratory Services Comprehensive Outpatient Rehabilitation Facilities Dialysis Centers Home Health Agencies Hospice Agencies & Residences Hospitals Nursing Homes Outpatient Physical Therapy (OPT)/Speech Pathology Providers Portable X-Ray Suppliers Rural Health Clinics
No. of Providers Type Michigan Covered Providers (As of December 29, 2015) * Some federal oversight for organ procurement organizations (1) and federally qualified health centers (215). 9,876 Child Care Homes & Centers 8,445 Clinical Laboratory Services (CLIA) 4,248 Adult Foster Care Homes 1,300 Substance Use Disorder Programs 1,061 Adult Foster Care/Child Care Camps 616 Home Health Agencies 460 Nursing Homes/LTC Facilities 234 Homes for the Aged 196 Dialysis Centers (ESRD) 169 Hospitals 168 Rural Health Clinics 160 Outpatient Physical Therapy (OPT)/Speech Pathology 141 Hospice Agencies 136 Freestanding Surgical Outpatient Facilities/ASC 58 Inpatient Psychiatric Hospitals/Units 18 Hospice Residences 9 Organ Transplant Facilities 9 Portable X-Ray Providers 5 Community Mental Health Centers 4 Comprehensive Outpatient Rehab Facilities (CORF)
State Federal Type BCHS State/Federal Oversight by Covered Providers YES NO Adult Foster Care Homes YES NO Adult Foster Care/Child Care Camps YES NO Child Care Centers YES NO Homes for the Aged YES NO Substance Use Disorder Programs YES YES Freestanding Surgical Outpatient Facilities/ASC YES YES Hospice Agencies YES YES Hospice Residences YES YES Hospitals YES YES Inpatient Psychiatric Hospitals/Units YES YES Nursing Homes/LTC Facilities NO YES Clinical Laboratory Services (CLIA) NO YES Community Mental Health Centers NO YES Comprehensive Outpatient Rehab Facilities (CORF) NO YES Dialysis Centers (ESRD) NO YES Home Health Agencies NO YES Organ Transplant Facilities NO YES Outpatient Physical Therapy (OPT)/Speech Pathology NO YES Portable X-Ray Providers NO YES Rural Health Clinics (RHC)
Regulatory Overview Sample of Events Requiring State/Federal Approval: Initiation/renewal of a state license (required) Initiation/recertification for federal certification to participate in Medicare/Medicaid (voluntary) Change of ownership (change in licensee/owner) Relocation Increase or decrease in beds Change in bed designations (Medicare, Medicaid, dual, licensed only) Change in information (administrator/facility name) Change in special designations - AFC
General Overview State Licensure Initial licensure Routine surveys/inspections Complaints Renewal Enforcement Federal Certification Initial certification Routine recertification surveys Complaints Recertification Enforcement
Survey Process Overview Entrance conference Review of survey process and methodologies Request for documents Record review Tour/observations Policy and procedure reviews Interviews Exit conference * Non-cooperation could end survey process and require state agency to recommend termination to CMS.
CMS FY 16 LTC Tier Workload Tier1 Tier 2 Tier 3 Tier 4 15.9 Month Maximum Interval Off-Hour Surveys, Special Focus Facilities Initial certification of new providers Complaint Investigations Triaged as Low 12.9 Month Average MDS Surveys MI 2-2.5%of LTC facilities Complaint Investigations Triaged as Medium Complaint Investigations Triaged as High or IJ Complaint Investigations Triaged Non-IJ High
New LTC Regions/ Teams
CMS Midwest Data Long Term Care (LTC) Facilities No. of Providers State (FY15) 961 Ohio 712 Illinois 531 Indiana 496 Missouri 428 Michigan 420 Iowa 379 Wisconsin 367 Minnesota 294 Kansas 199 Nebraska Average No. of Deficiencies State (FY15) 8.7 Kansas 6.4 Minnesota 6.4 Wisconsin 6.3 Michigan 5.6 Missouri 5.6 Nebraska 5.5 Indiana 5.2 Illinois 4.1 Ohio 4.0 Iowa 5.6 National Average MI Average No. of Deficiencies by Year 6.3 FY15 5.9 FY14 6.3 FY13 7.3 FY12 7.4 FY11 7.3 FY10
CMS FY15 Midwest Data continued LTC - Average Hours Per Standard Surveys
CMS Midwest FY15 Data Facility Incidents Reported No. of Providers State 961 Ohio 712 Illinois 531 Indiana 496 Missouri 428 Michigan 420 Iowa 379 Wisconsin 367 Minnesota 294 Kansas 199 Nebraska Incidents Received Incidents Per Provider Incidents Survey State 2,007 4.7 1,996 (99%) Michigan 746 1.5 647 (87%) Missouri 615 1.5 605 (98%) Iowa 502 0.7 499(99%) Illinois 374 1.3 358 (96%) Kansas 310 0.8 310 (100%) Wisconsin 235 1.2 224 (95%) Nebraska 170 0.2 169 (99%) Ohio 95 0.2 95 (100%) Indiana 2 <0.1 2 (100%) Minnesota
CMS FY15 Midwest Data continued LTC Top 5 Deficiencies/Standard Survey Michigan Tag Tag Description No. of Citations/ Percentageof Providers Cited F323 Free of Accident Hazards/Supervision/Devices 303/51% F309 Provide Care/Services for Highest Well Being 226/36% F441 Infection Control 215/42% F371 Food Procure,Store/Prepare/Serve Sanitary Conditions F226 Develop/Implement Abuse/Neglect, etc. Policies & Procedures 182/39% 166/32%
CMS Update continued FY 16 LTC Tier Workload Tier1 Tier 2 Tier 3 Tier 4 15.9 Month Maximum Interval Off-Hour Surveys, Special Focus Facilities Initial certification of new providers Complaint Investigations Triaged as Low 12.9 Month Average MDS Surveys MI 2-2.5%of LTC facilities Complaint Investigations Triaged as Medium Complaint Investigations Triaged as High or IJ Complaint Investigations Triaged Non-IJ High
BCHS Update State Licensing / Federal Survey & Certification Split State Licensure Inspections / Fees IDR/IIDR MRPO Involuntary Transfer / Discharge Facility Reported Incidents (FRI) e-poc / Federal Plans of Correction Nurse Aide Registry
Web Change www.michigan.gov/bchs
Questions & Answers Bureau of Community and Health Systems Ottawa Building, 1 st Floor 611 W Ottawa Street Lansing, MI 48909 Main Line: (517) 335-1980 www.michigan.gov/bchs Thank you for your efforts to provide quality community & health care Services to Michigan residents.