Timeline of Events Following Completion of a
Survey
PDF Version
of BQA 00-008 (PDF, 16 KB)
Date: Feburary 4, 2000 DSL-BQA-00-008
To: Nursing Homes NH 6
From: La Vern Woodford, Chief, Resident Care Review Section
cc: Susan Schroeder, Director, Bureau of Quality Assurance
When a recertification or complaint survey results in a finding
of noncompliance, it generates an enforcement timeline for subsequent events. This
timeline is based on the federal Health Care Financing Administration’s
(HCFA) State
Operations Manual, Chapter 50 of the Wisconsin Statutes, and the state Bureau of Quality
Assurance (BQA) procedures related to licensing and certification requirements.
The chart in this memorandum provides an overview of the enforcement process by
outlining major points on the timeline. It does not, however, include all requirements or
contingencies. In the event of a conflict between the chart and an official notice from
BQA or HCFA, or between the chart and a statute, regulation or rule, a nursing home should
rely on the official notice and applicable legal requirements.
This chart has three columns. The first column identifies the day the event occurs
following the completion of a survey. The timeline begins with Day 0, the day of the exit
conference at the completion of the survey. All other days represent the number of days
from the exit conference.
The second column describes an event that occurs, a deadline for action on a specified
day, or in a few cases, an activity that occurs at an approximate point on the timeline.
The third column describes enforcement actions that BQA or HCFA may take if BQA finds
new deficiencies during a time period when a nursing home has not corrected deficiencies
from a prior survey. It describes what occurs if new findings of noncompliance are
superimposed on the timeline generated by deficiencies from an earlier survey. There are
two important points. First, any federal remedies proposed in an earlier letter may be
modified depending on the scope and severity of any subsequent federal deficiencies issued
prior to the nursing home achieving substantial compliance. Second, any new deficiencies
become part of the timeline that was already in place. An example follows:
-
BQA concludes a complaint investigation and holds the exit conference on January 1st.
The nursing home has 90 days (until April 1st) to correct its federal
deficiencies before HCFA or BQA imposes mandatory denial of payment for new admissions.
BQA conducts a recertification survey on February 15th, before the nursing
home has corrected its January 1st deficiencies, and issues new citations.
The nursing home must correct both the old and the new citations prior to April 1st
(Day 90) to avoid denial of payment for new residents.
New deficiencies become part of any ongoing enforcement timeline whenever there are
outstanding deficiencies at the start of the new survey. A new enforcement timeline begins
only when the nursing home is in substantial compliance with all federal regulations at
the start of a survey.
The days in column one date from the exit conference. Day 90, for example, is ninety
days from the exit conference. Day 23, Day 90, and Day 180 are fixed dates because they
are the only days dependent upon the date of the exit conference. All other days are
conditional and depend on the day the nursing home (NH) receives the Statement of
Deficiencies (SOD). The following chart assumes the SOD is received on Day 10. If
the SOD is issued earlier or later than Day 10, then all the days (except Days 23, 90, and
180) are affected accordingly. For example, if the SOD is received on Day 8 rather than
Day 10, then the last day to request an in-person informal dispute resolution (IDR) is the
eleventh day from the exit conference (Day 11) rather than Day 13 and the last day to
appeal a state SOD is Day 18 rather than Day 20.
Day 0 |
Exit conference/completion of survey.
|
|
Day 10 (HCFA) |
NH receives SOD. NH notified of proposed remedies, or imposed remedies if
NH has no opportunity to correct.
|
Until the nursing home comes into compliance with the
federal deficiencies issued on Day, 10, any new federal deficiencies that are cited follow
these same time frames. For example, if an annual survey or complaint investigation
is conducted in conjunction with the revisit on Day 45 and new federal deficiencies are
issued, all federal deficiencies must be corrected prior to day 90 to avoid mandatory
denial of payment for new admissions. A new enforcement track begins only when there
are no outstanding federal deficiencies prior to the start of a survey. In addition,
any remedies proposed in the Day 10 letter may be modified depending upon the scope and
severity of any subsequent federal deficiencies issued prior to the NH achieving
substantial compliance.
|
Day 13 (BQA) |
Last day to request telephone or in-person IDR.
|
Day 17 (BQA) |
Last day to submit supporting documentation for IDR. (This date can be modified
through mutual agreement with the Regional Field Operations Director/RFOD.)
|
Day 20 (HCFA/Ch.50) |
Last date to submit plans of correction (POC).
|
(Chapter 50) |
Last date to appeal state violations (if SOD received on Day 10).
|
(HCFA) |
Last date to request IDR (desk review).
|
Day 23 (HCFA) |
Termination from Medicare/Medicaid program(s) if BQA cited immediate jeopardy and the
NH has not abated it.
|
Day 24 (BQA) |
Conduct informal dispute resolution (IDR) conference.
|
Day 30 (Chapter 50) |
Last date to approve plans of correction (POC).
|
Day 31 (BQA) |
Notify nursing home of IDR results.
|
Day 45 (approximate) |
Conduct revisit (must be done prior to Day 60). In some cases, the revisit may be
conducted in conjunction with a recertification survey or a complaint investigation.
|
Day 55 (HCFA) |
Issue SOD, if deficiencies found at the revisit. Notify NH of federal remedies (which
may differ from those initially proposed in the Day 10 letter).
|
Day 65 (HCFA/Ch.50) |
Last date to submit POC, to request IDR, and to appeal state violations (if SOD
received on Day 55).
|
Day 70 (HCFA) |
Last date to appeal federal remedies if remedies were imposed with the issuance of the
SOD on Day 10.
|
Day 80 (approximate) |
Conduct second revisit (if/when instructed by HCFA).
|
Until the nursing home comes into substantial compliance with
the federal deficiencies issued on Day 10 or following, any new federal deficiencies that
are cited follow these same time frames. Termination from the Medicare or Medicaid
programs will occur on Day 180 if a nursing home has no survey between Day 10 and Day 180
in which it is in substantial compliance with all federal nursing home regulations.
|
Day 90 (HCFA) |
Mandatory denial of payment for new admissions if nursing home has not been in
substantial compliance with federal regulations since Day 0.
|
(Chapter 50) |
Suspension of new admissions under Chapter 50 if nursing home meets the criteria
identified in s. 50.04(4)(d), Stats.
|
Day 115 (HCFA) |
Last date to appeal federal remedies if remedies were imposed on Day 55 following the
revisit.
|
Day 120 (approximate) |
NH receives notice of state forfeitures.
|
Day 130 (approximate)
Chapter 50) |
Last day to appeal state forfeitures (10 days following receipt of forfeiture notice;
assumes forfeiture notice received on Day 120.)
|
Day 180 (HCFA) |
Termination from Medicare and/or Medicaid program(s) if NH is not in substantial
compliance with federal regulations.
|
This chart outlines major points on the enforcement timeline. In the event of a
conflict between the chart and an official notice from BQA or HCFA, or between the chart
and a statute, regulation or rule, a nursing home should rely on the official notice and
any applicable legal requirements.
If you have questions, please contact the Regional Field Operations Director (RFOD)
assigned to your nursing home. The names, addresses, and phone numbers of the Regional
Field Operations Directors are listed below [via the regional
offices].
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