Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
In July 2016, the Centers for Medicare and Medicaid Services issued a memorandum on the mandatory imposition of federal remedies and assessment factors used to determine the seriousness of deficiencies for nursing homes.
Skilled Nursing Facilities, Nursing Facilities, and dually participating facilities are required to be in compliance with Medicare and Medicaid guidelines. Facilities have a responsibility to correct any deficiencies identified at the time of a Federal Survey in order avoid penalty, including termination of the provider agreement. CMS and State Survey agencies have no obligation to allow non-compliant facilities an opportunity to correct deficiencies prior to imposing federal enforcement remedies which include but are not limited to civil money penalties, directed plan of correction and temporary management.
Upon survey, if one or more residents are identified as having suffered significant harm, CMS is implementing a national policy that will require the use of federal enforcement remedies. Revisions were made to Chapter 7 of the State Operations Manual regarding the immediate imposition of Federal Remedies.
A civil money penalty must be imposed any time a:
Scope of Severity Level of J or higher (Immediate Jeopardy) is cited.
Based on the seriousness of the deficiencies or when actual harm of substandard quality of care is identified, federal remedies will be instituted.
Categories for Federal Remedy
- Category 1
Directed Plan of Correction; State Monitor; and/or Directed In-Service Training
- Category 2
Denial of Payment for New Admissions; Denial of Payment for All Individuals imposed by CMS; Termination; Temporary Management; and/or Civil Money Penalties
- Category 3
Temporary Management; Termination; Civil Money Penalties
Mandatory criteria for immediate imposition of federal remedies include any one or more of the following:
- Immediate Jeopardy “IJ” (Scope and Severity levels J, K and L) is identified on the current survey.
- Deficiencies of substandard quality of care that are NOT Immediate Jeopardy “IJ”, are identified on the current state survey.
- Any G level deficiency is identified on the current survey in regulations involving Resident Behavior and Facility Practices, Quality of Life, Quality of Care.
- Deficiencies of Actual Harm are identified on the current survey AND deficiencies of immediate jeopardy OR actual harm were identified on ant type of survey between the current survey and the last standard survey.
- A facility classified as SFF AND has a deficiency of “F” level or higher on its current survey.
Be mindful that the “current survey” is the Health and or Life Safety Code Survey currently being performed including standard, revisit, or complaint.
The effective date for the guidance outlined by CMS in the memorandum is for all surveys completed on or after September 1, 2016. There has been expressed concern throughout the SNF industry with the updated approach.
If you have questions or concerns about federal remedies, please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413.
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