Wednesday December 19, 2012

NEAL P. GOSWAMI

Staff Writer

BENNINGTON -- The Vermont Veterans Home will be under increased scrutiny "due to its history of noncompliance with quality of care and safety requirements," according to the state agency charged with overseeing the home.

Special Focus Facility

In a Dec. 7 letter, the state Division of Licensing and Protection informed the home that it is now designated a Special Focus Facility. According to the letter, the designation means the home will experience more frequent inspections and additional oversight. The state agency is the inspection agent for the Centers for Medicare and Medicaid Services, which provides the majority of funding for the home.

The home faced decertification and loss of the Medicare provider agreement in September because of issues identified during several inspections beginning in March. The state-run home had to correct at least three deficiencies, including an alleged assault of a resident by a nurse, that had been identified by inspectors. Decertification would have cost the home about $12 million in annual federal funding if the home had not passed another surprise inspection by Sept. 28.

Although the immediate threat of decertification was averted, the home will now face additional inspections. There will be at least two inspections per year instead of the one required for facilities without the SFF designation.


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The designation can be removed when the home has two consecutive clean inspections.

CMS has a progressive enforcement policy that allows for increasingly stringent enforcement action including monetary penalties, denial of payment for new admissions and possible termination of the Medicare provider agreement with the home. Any future deficiencies would face increased penalties.

Officials said Tuesday that additional oversight has been expected.

"It's nothing surprising to me. We didn't know exactly what was going to happen," said Board of Trustees President Joseph L. Krawczyk Jr. "You could expect that we were going to see them again and that's what will happen."

"My thoughts were, and I said right along to the staff, ‘Yeah, we dodged a bullet, but we're not out of the woods yet,'" he added.

Home Administrator Melissa Jackson said the enhanced scrutiny is an opportunity for staff and administrators to "show everybody that we mean business."

"I actually welcome the additional oversight because it gives us an opportunity to prove to the state and federal government that what happened back in September was just a fluke," she said.

Jackson said state inspectors have returned once since September to investigate a complaint. They spent a day reviewing documentation and interviewing staff and residents, but did not cite the home with a new deficiency, she said.

Frances L. Keeler, assistant division director with the Division of Licensing and Protection, said CMS requires the state to designate at least one facility as a Special Focus Facility at all times. "Some states have as many has five depending on the number of nursing homes in the state," she said. "A small state like Vermont always has one."

When one facility improves another is selected, according to Keeler. CMS provides a listing of potential facilities for the state agency to select from. The candidates are chosen from homes with the lowest facility scores following inspections.

History may be on the side of the Vermont Veterans Home. Keeler said CMS has not yet terminated a provider agreement with a Vermont facility that has received the designation.

"No facility in Vermont has been terminated due to failure to graduate. They've all managed to make improvements sufficient enough to come off of the designation. Some do it rather quickly, others take longer," she said.