Regulatory · 6 processes
The compliance file is the litigation file.
Almost nothing an operator produces is read by three audiences with such different purposes. The surveyor reads your plan of correction once. The underwriter reads it at every renewal for years. Plaintiff counsel reads it looking for an admission or for a promise you did not keep.
These pages take a regulatory process at a time and run it end to end: the sequence, the deadlines, what the process produces, and what that document does to your insurance program and to a case filed three years later. The glossary defines these terms in a paragraph. This is the procedure.
Each page states who it applies to. Conflating a federal certified-facility requirement with a state assisted living licensure rule is the most common error in this material, so the scope is stated rather than assumed.
Regulatory process
The survey process
How a standard or complaint survey actually runs, what the scope and severity grid does, how to use informal dispute resolution, and why the resulting document is read by plaintiff counsel and underwriters as well as by the state.
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Regulatory process
Writing a plan of correction
How to write a plan of correction that satisfies the regulator and survives the two audiences the regulator does not have in mind: the underwriter reading it at renewal and the plaintiff attorney reading it at trial.
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Regulatory process
Immediate jeopardy
What immediate jeopardy means, the removal plan and the timeline that follows, the enforcement remedies that attach, and what happens to a liability program after a finding at this level.
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Regulatory process
QAPI and privilege
What a quality assurance and performance improvement program has to contain, how the statutory protection for quality assurance committee records actually works, and how operators lose the protection without noticing.
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Regulatory process
Payroll-based journal
What payroll-based journal reporting requires, how the submitted data becomes a public staffing record, and why it is the single most useful document a plaintiff attorney gets for free.
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Regulatory process
Five-star ratings
How the federal five-star rating is constructed from health inspections, staffing and quality measures, what each domain is and is not evidence of, and how underwriters and plaintiff attorneys use the number differently.
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Adjacent
What the payers and lenders require on top of this.
Compliance is one source of insurance requirements. Conditions of participation, HUD Section 232 mortgage insurance, state licensure minimums and landlord lease exhibits are four more, and they rarely agree with each other.
Medicare and Medicaid requirementsFree coverage review
An underwriter is reading your survey history right now.
Send the declarations page and your recent findings with the corrections. A specialist tells you what that record is doing to your program and what to change before the next renewal, within one business day.