The Health & Human Services (HHS) Office of Inspector General (OIG) released an updated work plan on June 17 that includes two new items affecting nursing home members. First, OIG intends to evaluate the nursing homes Special Focus Facility program. OIG will assess CMS’s adherence to program requirements including six month inspections, revised criteria for graduation and termination from the program (implemented in 2022), and incorporation of strategies to help graduates maintain quality improvements. This report is expected in Fiscal Year (FY) 2025.

A second report, expected in FY 2026, will investigate Medicare Advantage Organizations’ (MAO) use of prior authorizations for post-acute care. OIG will examine MAOs’ processes for reviewing prior authorization requests, the extent to which prior authorizations were denied, and the settings to which patients were discharged. Review the updated work plan here.