Stethoscope with financial statement

The Centers for Medicare & Medicaid Services (CMS) recently issued new guidelines reversing policies put in place under President Obama scaling back the use and magnitude of civil monetary penalties (CMPs) levied against nursing homes for various infractions.

In an October 2017 memo, CMS outlined the related changes to the survey process. Then in November, the Trump administration exempted nursing homes that violate eight new safety rules from penalties for 18 months, however the new rules must still be followed. CMS will use the 18-month period to educate surveyors and providers on health and safety expectations and to allow time for compliance.

These changes are welcome news to SDAHO members given the recent significant increase in CMPs in the state. The issue was also discussed as part of recent legislative forums.

Data from last year indicates an increase in the number of higher level deficiencies being issued which typically result in CMPs being levied.  CMPs increased to more than $700,000 in South Dakota last year. South Dakota is not alone with this concern. Nursing homes across the nation struggle to deal with the financial consequences and administrative burden of dealing with penalties and have complained that the focus has been on catching wrongdoing rather than helping nursing homes improve.

We are fortunate in South Dakota to have a good relationship with the Department of Health (DOH). We recently discussed these issues with Secretary of Health Kim Malsam-Rysdon.  She confirmed that federal regulations are the driving force behind the imposition of CMPs.  However, she noted that overall the rate of deficiencies issued in the state has declined in recent years by roughly five percent (from 75 to 70 percent), adding that the national state average is approximately 86 percent of all nursing homes that receive citations.

To further strengthen the process, the DOH has added quality assurance measures aimed at improving the consistency of the overall survey process. Sec. Malsam-Rysdon encouraged providers to utilize the independent dispute resolution (IDR) process to help resolve disagreements with specific deficiencies.