CMS changes its policies on civil money penalties for nursing facilities

CMS has issued a Survey and Certification memo regarding a revision of their policies and the analytic tool used to calculate CMPs. The changes go into effect July 17.

In summary, the changes are as follows:

  • For past non-compliance, regional offices will impose a per-instance CMP rather than a retroactive per-day CMP, for any identified noncompliance that occurred before the survey but which is addressed and facility is in current compliance
  • The per-instance CMP will be the default for noncompliance (rather than retroactive per-day CMP) that is found to have existed before the survey and still exists at the time of the survey
  • The per-day CMP (retroactive) will remain in play for past noncompliance that existed before the survey and occurred where: 1) a resident suffers actual serious harm at the immediate jeopardy level, 2) a resident was abused, or 3) the facility had persistent deficient practices violating federal regulations
  • The per-day CMP (prospectively) will be the default for noncompliance found during the survey and beyond until in compliance. The only exceptions to forego a per-day for a per-instance will be for facilities with good compliance histories, and where a single isolated incident causes harm to a resident, unless abuse has been cited
  • The regional offices are to consider the timing of the revisit survey to certify compliance when imposing the final CMP amount
  • The CMS central office will review CMPs greater than $250,000

SDAHO has been strongly advocating at the federal level for changes with the CMS policy on CMPs. While this change does not resolve all of our concerns, it is a great improvement over the current policies where retroactive per-day CMPs are imposed, creating significant financial burdens for providers.