Michigan Medical Directors Association Sunday, September 17, 2017 10:15 to 11:15 a.m. State Licensure & Federal Certification Update Bureau of Community & Health Systems (BCHS) Larry Horvath, Director

Regulatory Oversight Bureau of Community & Health Systems (BCHS) - Effective July 6, 2015 State Licensing Health Facilities & Agencies (including Homes for the Aged) Life Safety Code Inspections of Long Term Care Facilities Substance Use Disorder Programs Child Care Homes & Centers Adult Foster Care Homes Federal Certification of Providers and Suppliers on Behalf of the Centers for Medicare and Medicaid Services (CMS) Workforce Background Checks Nurse Aide Training Program/Nurse Aide Registry (February 1, 2016) Plan Review/Construction Permits for State Licensed Health Facilities (Moved to Bureau of Construction Codes)

BCHS Organizational Overview Larry Horvath Bureau Director Mark Jansen, Director Child Care Licensing Division Jay Calewarts, Director Adult Foster Care & Camps Division Teri Dyke, Director Health Facility Licensing, Permits, and Support Division Michelle Roepke, Director Federal Survey & Certification Division Steve Gobbo Deputy Bureau Director BCHS Organizational Overview State Licensed Child Care Group Homes/Centers State Licensed Adult Foster Care Homes Adult Foster Care/Child Camps Homes for the Aged State Licensed Freestanding Surgical Outpatient Facilities Hospice Agencies & Residences Hospitals Nursing Homes Substance Use Disorder Programs Other Functions Complaint Intake Nurse Aide Training Program Nurse Aide Registry FOIA Federal Certification Ambulatory Surgical Centers Clinical Laboratory Services Comprehensive Outpatient Rehabilitation Facilities Dialysis Centers Home Health Agencies Hospice Agencies & Residences Hospitals Nursing Homes Outpatient Physical Therapy (OPT)/Speech Pathology Providers Portable X-Ray Suppliers Rural Health Clinics

Bureau of Community and Health Systems No. of Providers Type State License Federally Certified 9,461 Child Care Homes & Centers Yes No 8,187 Clinical Laboratory Services (CLIA) 4,241 Adult Foster Care Homes 1,376 Substance Use Disorder Programs 584 Homes Health Agencies 572 Adult Foster Care/Child Camps 460 Nursing Homes/LTC Facilities 248 Homes for the Aged 208 Dialysis Centers (ESRD) 206 Hospitals 171 Rural Health Clinics 155 OPT/Speech Pathology 152 Freestanding Surgical Outpatient Facilities 146 Hospice Agencies 64 Inpatient Psychiatric Hospitals/Units 17 Hospice Residences 9 Organ Transplant Facilities Portable X-Ray Providers 4 Comprehensive Outpatient Rehab (CORF) 3 Community Mental Health Centers Bureau of Community and Health Systems Covered Providers (As of February 2017) Some federal oversight for organ procurement organizations (1) and federally qualified health centers (241). 52,297 Certified Nurse Aides Registered

Regulatory Overview Sample of Events Requiring State/Federal Approval: Initiation/renewal of a state license (required) Initiation/recertification for federal certification to participate in Medicare/Medicaid (voluntary) Change of ownership (change in licensee/owner) Relocation Increase or decrease in beds Change in bed designations (Medicare, Medicaid, dual, licensed only) Change in information (administrator/facility name) Change in special designations - AFC

General Overview State Licensure Federal Certification Initial licensure Routine surveys/inspections Complaints Renewal Enforcement Federal Certification Initial certification Routine recertification surveys Recertification

CMS FY 17 LTC Tier Workload 15.9 Month Maximum Interval Off-Hour Surveys, Special Focus Facilities Initial certification of new providers Complaint Investigations Triaged as Low 12.9 Month Average MDS Surveys – MI 2-2.5% of LTC facilities Complaint Investigations Triaged as Medium Complaint Investigations Triaged as High or IJ Complaint Investigations Triaged Non-IJ High

CMS LTC Survey Changes New LTC Regulations – November 2016 State Agency Training – September 2017 New Survey Process – November 2017 Electronic survey process that combines QIS and traditional survey processes along with new F-Tag re-numbering Abbreviated and Revisit Guidance Interpretive Guidance – Phase II

BCHS Additional Updates State Licensing Waiver Process Federal Survey & Certification Split IDR/IIDR – MRPO Involuntary Transfer / Discharge Nurse Aide Registry / Nurse Aide Training Program Homes for the Age Legislation

CMS FY17 Data Quality of Care Citations MI Description of Citation % of Surveys w/ Citations 1 Free of Accident Hazards/Supervision/Devices 54.3% 2 Provide Care/Services for Highest Well Being 36.2% 3 Treatment/Services to Prevent/Health Pressure Sores 21.0% 4 ADL Care Provided For Dependent Residents 16.4% 5 Drug Regimen is Free From Unnecessary Drugs 13.1% US Description of Citation % of Surveys w/ Citations 1 Free of Accident Hazards/Supervision/Devices 41.6% 2 Provide Care/Services for Highest Well Being 34.7% 3 Drug Regimen is Free From Unnecessary Drugs 20.2% 4 Treatment/Services to Prevent/Health Pressure Sores 17.0% 5 ADL Care Provided For Dependent Residents 14.9%

CMS FY16 Data Total Deficiencies Cited by Survey Type and Severity Level Michigan Standard Tags Cited % Distribution Complaint Level 4 18 0.6% 36 2.9% Level 3 86 2.7% 135 10.9% Level 2 2,915 91.3% 1,051 85.0% Level 1 175 5.5% 14 1.1% US Standard Tags Cited % Distribution Complaint Level 4 654 0.8% 1,336 4.4% Level 3 1,775 2.1% 2,302 7.5% Level 2 78,494 92.8% 26,294 85.6% Level 1 3,634 4.3% 780 2.5%

CMS FY16 Data Number and Percentage of Enforcement Cases Transferred to the RO by Type of Sanction State # Transferred to RO # of CMPs in Effect % Cases w/ CMPs # DOPNA % Cases w/ DOPNA Michigan 590 125 21.2% 33 5.6% State 1 408 180 44.1% 19 4.7% State 2 231 85 36.8% 4 1.7% State 3 202 75 37.1% 18 8.9% State 4 121 74 61.2% 15.7% State 5 77 23 29.9% 5 6.5%

BCHS Web Page www.michigan.gov/bchs

BCHS Web Page Continued… www.michigan.gov/bchs

Questions & Answers Bureau of Community and Health Systems Ottawa Building, 1st Floor 611 W Ottawa Street Lansing, MI 48909 Main Line: (517) 335-1980 www.michigan.gov/bchs Thank you for your efforts to provide quality community & health care Services to Michigan residents.