A deficiencies in 1994. The facility avoided termination each time by correcting its
deficiencies prior to termination. The facility underwent a change of ownership on
06/01/1996. Since 07/01/1995, the facility had been out of compliance in 1996, 1997,
and 1998 surveys, but avoided enforcement remedies by attaining compliance before
remedies were imposed. The highest level of noncompliance had been at level G during
this time with no substandard quality of care. Thus, between the change of ownership in
1996 and the current cycle of surveys leading to termination, the facility’s compliance
history had been fair.
The termination - The facility was terminated from both programs on 08/08/1999, for
failure to attain substantial compliance with program requirements as demonstrated on
five State visits within a 6-month period. The survey cycle started with a 02/08/1999
complaint investigation that revealed 22 deficiencies, with no actual harm, and the
highest scope and severity of one level F (substandard quality of care due to poor record-
keeping of criminal background checks). After an opportunity to correct, a revisit and
another complaint investigation conducted on 04/12/1999 revealed continued
noncompliance, again with 22 deficiencies, many of which were the same deficiencies
(again, no harm). A second revisit on 06/16/1999 revealed continued noncompliance
with 10 deficiencies, two of which were at level G. The third revisit on 07/26/1999 was
also a standard survey, which revealed 28 deficiencies, with no harm and no substandard
quality of care. At this point the organization infused the facility with many additional
resources and a decision was made to revisit a final time. The final revisit was conducted
on 08/10/1999 and found only three deficiencies at the noncompliance level (two level
D’s and one level E). Termination was effective 08/08/1999 since the facility was not in
substantial compliance within 6 months.
Reasonable Assurance Decision - The facility first applied for Medicaid-only
recertification. Medicare certification was not initially sought due to the delay in Form
CMS-855 review by the fiscal intermediary, the prohibition on the conduct of a Medicare
survey pending Form CMS-855 clearance, and the absence of a reasonable assurance
requirement for re-entry into the Medicaid program. Since this would be the initial
certification survey for Medicaid, the tasks of both the standard and extended surveys are
required, as well as confirming compliance with all regulatory requirements. The
Medicaid re-entry survey was conducted on 09/11/1999, with only two level B
deficiencies. The facility was certified for Medicaid effective 09/11/1999, the date of
receipt of an acceptable plan of correction. On 09/12/1999, the facility applied for re-
entry into the Medicare program. After Form CMS-855 clearance by the fiscal
intermediary on 11/15/1999, the CMS Location determined that, based on the initial
Medicaid survey, the cause for termination had been removed. The CMS Location
established a reasonable assurance period of 90 days from the date of the Medicaid
survey on 09/11/1999. Thus, the second reasonable assurance survey, a standard survey,
would be conducted after 12/11/1999.
Rationale - A 90-day reasonable assurance period was chosen due to the fact that the
facility remained out of compliance, having many of the same deficiencies over a 6-
month period. A longer period was not deemed necessary in consideration of the