CMS's Reliance on California's Licensing Surveys of Nursing Homes Could Not Ensure the Quality of Care Provided to Medicare and Medicaid Beneficiaries

In California, the Department of Public Health, Licensing and Certification Division (State agency), must perform licensing surveys of nursing homes every 2 years to determine whether they meet the licensing requirements. Our review examined whether CMS's reliance on the State agency's licensing surveys of nursing homes ensured quality of care and adequate protection for beneficiaries. We found that nursing homes did not always meet certain State requirements for employee health examinations and optional service units. The licensing surveys did not always identify these issues; therefore, CMS's reliance on these surveys could not ensure quality of care and that adequate protection was provided to Medicare and Medicaid beneficiaries. The nursing homes and the State agency could not be sure that nursing home employees were free of any health conditions that might have created a hazard for Medicare and Medicaid beneficiaries. Further, they could not always demonstrate that optional service units, which provided specific types of care, such as physical therapy, at the nursing homes met State requirements for adequate policies and procedures, staff, equipment, and space.

To ensure quality of care and the adequacy of the protection provided to Medicare and Medicaid beneficiaries in nursing homes, we recommended that CMS work with the State agency to ensure that (1) nursing homes implement and follow adequate policies and procedures for employee health examinations and request approval for optional service units, (2) the State agency conducts all required licensing surveys and reviews employee health examination records during those surveys, and (3) the State agency improves licensing survey procedures for reviewing employee health examination records and the three required components and determining whether optional service units operated by the nursing homes are approved and optional services are listed on the licenses. CMS concurred with all of our recommendations and provided information on actions that it planned to take to address our recommendations.