Remedies…Fines…Impositions…What does all this mean?
This week we dive into the most commonly imposed remedies for non-compliance in a SNF. Many facilities and leaders struggle to understand the meaning behind these terms and how to maneuver through the impositions. QSR5 gives a few brief explanations in this week’s blog post and encourages providers to contact us to provide support as you walk through achieving substantial compliance.
Directed In-Service Training (DIT)
The regulatory division of each state or CMS may require a facility to complete DIT when there is a pattern of non-compliance with repeated deficient practice. This is also used as a common imposition when a facility receives a high scope and severity citation at a level G or above. DIT must be conducted by an agent or firm that has been approved by the state agency to conduct such education. The cost for a DIT is left to be paid for by the facility and is typically not approved to be someone from the facility’s governing body. The education must correlate directly with the deficient practice that was cited and the content of the education must be submitted to the state agency for prior approval.
Denial of Payment for New Admissions (DPNA)
Another remedy that can be imposed by CMS is a DPNA that is applied when a skilled nursing facility is not in compliance with the conditions of participation for Medicare. DPNA is typically set 90 days after the survey exit so the facility has time to correct the deficient practice. However, if the citation is at a G level or above, the timeline for corrective action is much shorter and can be as little as two weeks post survey exit. DPNA applies to any new admissions to the facility and a beneficiary notice must be provided to the potential patient that explains the non-coverage. This can be quite costly for a facility that typically sees multiple admissions per week. The DPNA is normally rescinded once the survey agency has accepted and approved the plan of correction including a re-visit if warranted.
Civil Monetary Penalty (CMP)
A CMP is a civil monetary penalty issued and imposed by CMS against a nursing home for either several days or for each instance a nursing home is not in substantial compliance with one or more Medicare and Medicaid participations requirements.
Many providers receive a CMP when a high-level scope and severity citation is given for failing to meet minimum compliance requirements. CMPs may also be imposed when citations are repeatedly given, and the facility does not meet substantial compliance.
Once CMPs are assessed the facility can choose to forego the appeal process for the deficient practice and typically will be given a 35% reduction in the fine which can be extremely helpful when there is little to no opportunity to win an appeal. Note: this does not include the IDR process, as you may decide to submit an IDR and not move forward with an appeal.
Of course, the best option is always to remain in substantial compliance so that your facility isn’t facing a DIT, DPNA or a CMP, but if you find yourself in this situation, work through the corrective action and you’ll be set on the road to successfully providing quality care to your residents in no time!