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Fed Shutdown Halts Inspections

a nurse checks the heart of an elderly patient

Florida's nursing-home inspectors have been ordered to curtail all work except complaints about life-and-death dangers because of the federal government's shutdown. Other health-care facilities and programs may be affected, as well.

State inspections and certification of health-care institutions and programs comprise one of the less-well-known pockets of federal spending affected by Congress' halt in funds for most government operations as of the beginning of fiscal year 2014 on Oct. 1.

An arm of the U.S. Department of Health and Human Services contracts with state agencies to conduct inspections and investigate complaints for programs that receive Medicare or Medicaid funds. The list includes hospitals, home-health agencies, ambulatory surgical centers, health clinics, kidney dialysis centers and others. (List is on this page, scroll down to "Federal Regulations.")

The Florida Agency for Health Care Administration carries out the inspections on contract with HHS' Centers for Medicare and Medicaid Services (CMS).  AHCA also handles complaint investigations that may involve "immediate threats to life or safety."

AHCA spokeswoman Michelle Dahnke said Friday that there is still money available for the emergency investigations. She said there is still time to reschedule the postponed nursing home surveys that are required every 15 months for continued certification.

The stand-down order to state survey agency directors came Oct. 1 from Thomas E. Hamilton,  the director of the CMS office on surveys and certification.  He said CMS officials are "doing our utmost" to protect Medicare and Medicaid beneficiaries and health-care service providers from suffering harm.

The memo lists functions that must be continued during the shutdown and those that should not. A few of the non-urgent functions can be continued despite the shutdown because the source of funding is not part of the general appropriations process. Examples are clinical laboratories and background checks.

The list of essential state survey and certification activities that must be continued during the shutdown include complaints that appear credible and involve "immediate jeopardy or harm to an individual."  Also to be continued are revisits to previously sanctioned facilities to check on compliance if postponement would result in the facility's loss of federal funds and probable closure.

Activities that must be curtailed, according to the letter, include visits for initial Medicare certification or recertification and complaint investigations that do not involve immediate jeopardy or harm.

"In the event of a federal government shutdown that persists for more than a few weeks, CMS will communicate further instructions...," Hamilton wrote. He named an administrator who will be on duty while others are furloughed.

Hamilton said "we deeply regret" the necessity of the memo and thanked the states "for your patience during this time of uncertainty."

The Florida Health Care Association, which represents nursing homes in the state, said the shutdown has had no real impact on her members. "Our facilities are committed to doing what they do and providing the highest quality of care; the (shutdown) isn't going to affect that," said Kristen Knapp. "We're still operating business as usual."