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

2. 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)

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

10. CMS FY17 Data Quality of Care CitationsMI
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%

11. 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%

12. 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%

13. BCHS Web Page www.michigan.gov/bchs

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

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