Health Care Law Blog

Nursing Home Update - 50% Reduction in Civil Money Penalties

The Centers for Medicare and Medicaid Service's (CMS) recently published Final Rule related to Civil Money Penalties for Nursing Homes implements provisions of the Patient Protection and Affordable Care Act related to the nursing home enforcement process. 

One important highlight of the Final Rule is a 50% reduction of a civil money penalty for self-reporting and prompt correction.  In order to take advantage of the 50% reduction, CMS identifies the following conditions that must be met:

• The nursing home must self-report noncompliance before CMS or the State learns about it from other sources. 
• The nursing home must correct noncompliance within 15 calendar days of the incident causing the noncompliance or 10 calendar days from the date the civil money penalty was imposed, whichever is earlier. 
• The reported noncompliance cannot have involved immediate jeopardy, a pattern of harm, widespread harm or have resulted in a resident's death. 
• The reduction will not be available to nursing homes with repeated noncompliance that involved a penalty reduction during the previous year.
• The nursing home must meet the mandatory reporting requirements for the incident on which the civil money penalty was based.
• The nursing home must waive its right to a hearing.
• The nursing home may only receive one (not both) of the available civil money penalty reductions (i.e., it must choose between the 50% and 35% reductions).

Other highlights of the Final Rule include (i) an opportunity for an independent informal dispute resolution process; (ii) the establishment of an escrow account for civil money penalties; and (iii) a designation of acceptable uses of civil money penalty funds collected by CMS.

The Final Rule becomes effective on January 1, 2012.   For assistance in readying your nursing home prior to CMS' implementation of the Final Rule, please contact Mindi Johnson at 616.726.2252.

Categories: Compliance, Regulatory