CMS Issues Guidance on the Imposition of Remedies
In an effort to address inconsistencies in the application of remedies on a national level, the Centers for Medicare and Medicaid Services (CMS) has issued S&C letter 16-31. The S&C letter states that CMS and the State Survey Agencies (SAs) have no statutory or regulatory obligation to provide noncompliant facilities an opportunity to correct their deficiencies prior to immediately imposing federal enforcement remedies (e.g., CMP, directed plan of correction, temporary management, etc.).
As outlined in the letter, nursing homes will not be given an opportunity to correct deficiencies before remedies are imposed under the following conditions:
- Immediate Jeopardy (IJ) identified on the current survey.
- Deficiencies of Substandard Quality of Care (SQC) that are not IJ are identified on the current survey.
- Any G level deficiency is identified on the current survey in Resident Behavior and Facility Practices, Quality of Life, or Quality of Care.
- Deficiencies of actual harm are identified on the current survey and deficiencies of immediate jeopardy or actual harm were identified on any type of survey between the current survey and the last standard survey.
- Facility is classified as a Special Focus Facility (SFF) and has a deficiency of F level or higher on its current survey.
In June 2016, CMS issued S&C letter 16-27 providing a state-by-state comparison of enforcement remedies used by various states between 2006 and 2014. There was significant variation in what remedies were applied by individual states. This latest S&C letter would appear to address this inconsistency. Our observation in NYS shows similar patterns in terms of Regional Office imposition of Category I remedies (DPOC, Directed Inservice), and it is expected that the latest S&C letter will result in increased imposition of Category I remedies.
Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832