OIG 2023-2024 Compliance Guidance for Long Term Care Facilities is summarized to highlight importance of a compliance committee and the responsibility to assist the chief compliance officer to develop a robust facility risk assessment. From that assessment the committee would need to develop meaningful and accessible policies and procedures to guide all levels of the facility staff and consultants of their roles and responsibilities in maintaining healthcare compliance.

In this episode, I will discuss the OIG November 2023 Compliance Officer Roles and Responsibilities guidance. The compliance officer has a responsibility to develop policies and procedures, conduct risk assessments, provide education and training, and promptly investigate any reports of abuse or fraud. They must also foster a culture of open communication and transparency within the organization and have open access to the board to report concerns and updates on the compliance program.

In this podcast episode, the host discusses the 2023 and 2024 updates to OIG's compliance program guidance (CPGs). These updates include a move to publishing the CPGs on the OIG website and the addition of a section on quality and patient safety. The host emphasizes the importance of incorporating quality and patient safety into compliance programs and discusses their personal experiences as a health care analyst working with corporate integrity agreements. The episode concludes with a quote from the OIG summary,

Skilled nursing facilities are facing changes in CMS survey guidance regarding unnecessary use of psychotropic medications. CMS is closely monitoring the use of these medications, which can be considered chemical restraints, and is asking facilities to focus on behavior interventions to minimize use. CMS is emphasizing the importance of professional standards of practice and the role of the medical director in monitoring the use of these medications. The use of psychotropic medications, including antipsychotics, antidepressants, anti-anxiety drugs, and hypnotics, in elderly residents in nursing homes should be carefully monitored and documented by prescribing practitioners. These medications can have serious side-effects and should only be used for residents with a clear diagnosis of a mental health condition or medical condition. The use of non-pharmacological interventions should be attempted before resorting to psychotropic medications. CMS has requested that skilled nursing facilities develop multidisciplinary teams to monitor psychotropic medication use in their residents, due to concerns about unnecessary use, adverse effects, and lack of comprehensive assessments. CMS is also moving psychotropic medications to F605 in an attempt to highlight the importance of proper medication management that has the potential for chemical restraint effects. This episode focuses on why CMS is making this request and the risks associated with psychotropic medication use in the elderly. A follow-up episode will discuss the need for comprehensive assessments, behavior interventions, and chemical restraints as a result of inappropriate use of psychotropic medications.

Summary

The CMS has released updated guidance on the long-term care survey process, focusing on accuracy of the MDS, medical director responsibilities, psychotropic medications and chemical restraints. In addition, the CMS issued clarifications for enhanced barrier precautions, pain management, quality assurance and performance improvement, health care equity, and prohibits certain language in admission agreements. It is important to recognize that healthcare surveyors will be looking for supporting documentation for the use of psychotropic medications. This episode discusses the updated Appendix PP which contains critical element pathways which surveyors will use during the nursing home survey process. These critical element pathways include the unnecessary medications pathway and the discharge pathway. The unnecessary medications is an important resources tool all facilities should carfully review especially for residents with dementia and schizophrenia diagnoses and receiving psychotropic medications.