Spring Forecast – Stormy Weather in Store for SNFs Without Comprehensive Care Plans and Discharge Plans

April 3, 2013

As skilled nursing facilities
(SNFs) prepare for their annual surveys they should pay particular attention to
their care plans and discharge plans. An Office of the Inspector General (OIG)
report dated February 1, 2013 found that SNFs often fail to meet care planning
and discharge planning requirements. The report is based on a study of medical
records of a stratified random sample of SNF stays from 2009.

  • An SNF is required to develop a
    comprehensive care plan that:  
  • Is
    prepared by an interdisciplinary team within seven days after completing a
    comprehensive assessment of a resident
  • Includes
    measurable objectives and timetables
  • Is
    tailored to meet a resident’s medical, nursing, mental, and psychosocial needs
  • Describes
    the services to be provided to attain or maintain the highest practicable
    physical, mental, and psychosocial well-being of the resident  

SNFs are also required to have
a discharge plan for each beneficiary being discharged to another facility or
home that includes a summary of the resident’s stay and status at discharge,
and a post-discharge plan of care to ensure that the beneficiary’s subsequent
needs are met.

The OIG found that for 37
percent of the stays, SNFs did not meet the regulatory requirements related to
developing care plans, or they did not provide services in accordance with care
plans. In addition, the OIG found poor quality of care in the areas of wound
care, medication management, and therapy.

The OIG also found that for 31
percent of stays, SNFs did not meet at least one discharge planning
requirement. Specifically, 16 percent of the SNFs did not provide a summary of
the resident’s stay and status at discharge, and more than 23 percent did not
provide a post-discharge plan of care. Not providing a post-discharge plan of
care or providing an inadequate post-discharge plan of care can pose a significant
risk to beneficiaries post discharge. SNFs may face potential liability for
negligence if beneficiaries suffer harm as a result.

Based on its findings, the OIG
recommended that the Centers for Medicare & Medicaid Services (CMS) take
the following five steps:  

  • Strengthen
    the regulations on care planning and discharge planning
  • Provide
    guidance to SNFs to improve care planning and discharge planning
  • Increase
    surveyor efforts to identify SNFs that do not meet care planning and discharge
    planning requirements and to hold these SNFs accountable
  • Link
    payments to meeting quality-of-care requirements
  • Follow
    up on the SNFs that failed to meet care planning and discharge planning
    requirements or that provided poor quality care  

CMS agreed with the OIG’s recommendations.
SNFs can therefore expect CMS to propose revisions to its regulations governing
care plans and discharge plans. SNFs also can expect the Department of Public
Health surveyors to pay particular attention to these areas when they conduct
their annual surveys.  

If you have questions about the
regulatory requirements pertaining to care plans and discharge plans, or
require any assistance in responding to Department of Public Health survey
deficiency reports, please contact Rochelle
H. Zapol
, a partner in Prince Lobel’s Health
Care Practice
and the author of this Alert. You can reach Rochelle
at 617 456 8036 or

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