The FY 2016 – FY 2017 Nursing Home Action Plan recently released by the Centers for Medicare & Medicaid Services (CMS) includes five strategies to help guide CMS towards achieving its goal. We have discussed Strategy 1, “Enhance Consumer Awareness and Assistance” and Strategy 2, “Strengthen Survey Processes, Standards and Training” on the CMSCG Blog in the past few days and now will take a look at the next strategy. Strategy 3 of the Nursing Home Action Plan is “Improve Enforcement Activities.” It makes sense that if CMS is going to be improving its survey processes and data collection in its efforts to improve the quality of care being provided in nursing homes, that it would look to improve use of its enforcement remedies for facilities that do not maintain compliance with Federal regulations. CMS has been hard at work on Strategy 3 – let’s see how:
- Improving Enforcement Policies – CMS has been tracking the use of enforcement remedies and how they vary from state to state to identify steps that can be taken to strengthen consistency in following enforcement procedures. Additionally, some consumer advocacy groups have been doing their own analyses of enforcement penalties that are being used (or not). In March 2014, a S&C letter addressed use of the Independent IDR (IIDR), escrow accounts, potential for a 50 percent reduction in a CMP related to self-reported non-compliance and use of CMP funds, along with other reminders to surveyors. In the new Action Plan, CMS states that in July 2016, Chapter 7 of the SOM will be revised to include information on where remedies must be imposed, clarify guidance to surveyors, and ensure that there is a consistent national application of enforcement policies and remedies. Also slated to arrive in July 2016 are Nursing Home Enforcement Reports.
- Monitoring Use of Civil Monetary Penalty Analytic Tool – CMS will continue to use the CMP Analytic Tool to check on consistency of enforcement remedies. SOM revisions will be implemented in July 2016 that will affect several per instance CMPs.
- Increasing use of the Federal Civil Monetary Penalty Fund – Well, once CMS has completed its work on drafting the multi-year CMP solicitation plan, it will have the guidance ready to help nursing homes secure funds to implement initiatives such as reducing adverse events, enhanced staffing, and improved dementia care (all parts of the focused surveys initiative).
- Updates to the Special Focus Facilities (SFF) Program – Effective April 2014, CMS made changes that required a specific number of slots and candidates for inclusion in the SFF Program per state, and also updated its requirements to encourage facilities to be moved through the program more rapidly with its 18 month “last chance” on-site survey. It does not look like many new changes are going to be made to this section of the Action Plan, but it notes that it is developing further guidance on SFF enforcement on an “ongoing” basis.
- Procedures for Nursing Home Closures – A final rule was issued in 2013 with information on the requirements for any nursing home that was planning to close, including written notice of closure. CMS notes in this 2016/2017 Action Plan that an action in Fall 2015 was to “finalize guidance” related to requirements for notification of closure and also to “finalize collection procedure OFM” for sanctions against nursing home administrators who had not properly provided this information in Chapter 7 of the SOM. This final information is being awaited.
Let’s see if we see an increasing amount of enforcement actions in the near future. Have you seen an uptick in your state? Reply to this post and let us know so we can share with our readers.