State of Missouri Single Audit Corrective Action Plan Year Ended June 30, 2022 State Agency: Department of Health and Senior Services (DHSS) Audit Finding Number: 2022-007 Medicaid Facility Survey Timeliness Name of the contact person responsible for corrective action: Shelly Williamson, Ad...
State of Missouri Single Audit Corrective Action Plan Year Ended June 30, 2022 State Agency: Department of Health and Senior Services (DHSS) Audit Finding Number: 2022-007 Medicaid Facility Survey Timeliness Name of the contact person responsible for corrective action: Shelly Williamson, Administrator, Section for Long Term Care Regulation, Division of Regulation and Licensure Anticipated completion date for corrective action: December 31, 2023 Corrective action planned is as follows: As The Missouri Department of Health and Senior Services (DHSS) returned to surveying activity following the survey suspension imposed during the Public Health Emergency, it found the gap between surveys has resulted in an increase in both the number of and the severity of violations in long term care facilities. These increases have caused greater time being devoted to investigating these violations and the attendant write up activity, including the Statement of Deficiency. In addition, the number of serious complaints has risen significantly since the pandemic. For example, the number of complaints prioritized as immediate jeopardy (requiring initiation within 24 hours of receipt) has increased by 194% since 2019. Because of the seriousness of these complaints, often surveyors have to be reassigned to investigate these complaints, which results in a delay in conducting revisits or sending statements of deficiencies timely. DHSS continues to experience staffing shortages, particularly in the Registered Nurse job classification, which impacts the ability to complete work consistently within the prescribed time frames. Each recertification survey requires at least one team member to be a Registered Nurse and due to the nature of many complaints, a Registered Nurse must also complete these investigations. There has been no meaningful increase in the federal budget since 2015, which further impacts the ability to hire and retain Registered Nurses. In addition, there is an ongoing shortage in the labor market for these professionals. The shortage has driven salaries well beyond the surveyor salary structure. DHSS has experienced turnover among surveyors leaving for other opportunities at a much higher salary. The shortage also limits the number of available candidates, and candidates routinely will not apply for positions or even show up for interviews because of the salary gap. In order to attempt to meet these time frames, DHSS has and will continue to request additional funding from both federal and state sources to increase salaries across the board for Registered Nurses and other survey staff. As a short-term, time-limited solution possible through one-time additional funding from the Centers for Medicare and Medicaid Services, DHSS has contracted with third-party entities to complete recertification surveys so that DHSS staff can continue to focus on completing work timely.