Seema Verma, the Centers for Medicare & Medicaid Services administrator, signaled, in a blog post this week, that state survey agencies will be increasing their long-term care enforcement efforts.

Since her appointment by President Trump, Ms. Verma has overseen comprehensive changes to nursing home oversight, from the Patient-Driven Payment Model shift to her flagship five-point plan on strengthening skilled nursing regulations. Under Verma’s watch, CMS has drilled down on staffing; overhauled the five-star rating system to specifically make it more difficult for operators to reach and maintain high marks; and set out to reform the state-level agencies that perform regular nursing home inspections on behalf of the federal government.

Enhanced enforcement is the agency’s next step in the previously announced five-part initiative to improve nursing home quality and safety standards. CMS has done a comprehensive review of its enforcement mechanisms and is making “significant [and] creative enhancements” to its enforcement efforts, according to Verma.

Targeted improvement areas included oversight of state survey agencies (SSAs) and better communication with SSAs and providers on expectations. CMS is also focusing on collaborating directly with corporate leaders of nursing home chains and staffing levels at facilities.

Ms. Verma noted in her blog post that CMS also plans to “take a hard look” at its civil money penalties that it imposes on nursing homes for noncompliance. The agency plans to announce new policies regarding penalties that promote equity and reduce variation.

The agency has also requested $442 million for survey and certification work, a $45 million increase from last year, as part of the FY 2021 budget. “The increased funding would enable CMS to continue to meet the statutory survey requirements while dealing with the increase in volume and severity of complaints, and rising survey costs,” Verma wrote in her blog post.

Also, as part of its work on the five-part initiative, on Friday, CMS released a memo to surveyors announcing the release of two additional toolkits as part of the five-part initiative.

The first toolkit, the Developing a Restful Environment Action Manual (DREAM) Toolkit, offers educational resources and practical interventions for residents with dementia that can be implemented by nursing home administrators, directors of nursing and staff to promote high-quality sleep.

The second, the Head-to-Toe Infection Prevention Toolkit, includes resources for staff to help prevent common infections by improving activities of daily living care.

Long-term care owners and operators should be prepared.