SOM Chapter 7 Flashcards

Abbreviated Standard Survey

• A survey that gathers information primarily through resident-centered techniques to assess facility compliance with participation requirements.

Compliance and Noncompliance

• Certification of Compliance indicates a facility meets substantial compliance for CMS participation in Medicaid or Medicare.
• Certification of Noncompliance signifies that a facility fails to meet substantial compliance and thus is ineligible for Medicaid or Medicare programs.
• Noncompliance refers to any deficiency causing a facility not to be in substantial compliance.

Abuse and Neglect

• Abuse involves the willful infliction of harm, unreasonable confinement, or intimidation resulting in physical or mental distress.
• Neglect pertains to the failure to provide necessary goods and services to prevent physical harm or mental anguish.

Deficiency and Immediate Jeopardy

• Deficiency indicates a facility's failure to meet participation requirements as specified in the Act.
• Immediate Jeopardy means noncompliance that can likely cause serious injury, harm, impairment, or death to a resident.

Surveys and Evaluation Types

• Standard Survey: Periodic inspections to assess service quality and compliance with participation requirements.
• Abbreviated Standard Survey: May occur based on specific complaints, changes in management, or indication of concerns.
• Expanded Survey: An extension of a standard survey due to suspected substandard care.
• Extended Survey: Evaluates additional participation requirements found to be deficient during previous surveys.
• Partial Extended Survey: Assess participation requirements subsequent to identifying substandard care.

Survey Entities

• State Survey Agency (SA) is responsible for conducting surveys to certify compliance with CMS participation requirements.
• State Medicaid Agency oversees the administration of the Medicaid program.

Training and Competency

• NATCEP: Nurse Aide Training and Competency Evaluation Program, essential for nurse aides providing services in facilities.

Enforcement and Remedies

• Enforcement Action can include penalties like termination of provider agreements or temporary management during noncompliance.
• No Opportunity to Correct (NOTC) leads to immediate remedies following noncompliance determination.
• Opportunity to Correct (OTC) allows facilities to address deficiencies before penalties are applied.

Family and Representation

• Immediate Family includes legal relations such as spouse, parent, child, sibling, etc.
• Representative is defined for purposes of educational programs as those involved in advocating for residents, including family and legal representatives.

Quality of Care Standards

• Substandard Quality of Care denotes levels of compliance resulting in immediate jeopardy or widespread harm.
• Substantial Compliance indicates identified deficiencies pose minimal risk to resident health or safety.

Miscellaneous

• Self-Reported Noncompliance is when a facility alerts State agencies to its deficiencies before official identification by regulators.
• Per Day Civil Money Penalty applies daily for periods not in substantial compliance; civil penalties can also be imposed per incident of noncompliance.