Medicare agency issues regulations for nursing home civil money penalties

The Medicare agency on Monday published proposed regulations regarding civil money penalties for nursing homes that fail to meet Medicare and Medicaid program participation requirements. The penalties were called for in the healthcare reform law.

According to a memo from the Centers for Medicare and Medicaid Services (CMS) to congressional health staffers, the proposed regulations would: 

• Permit CMS, after the conclusion of any informal dispute resolution, to collect and place the civil money penalties into an escrow account pending the resolution of any formal appeal;

• Provide an opportunity for an independent Informal Dispute Resolution (IDR) when a penalty has been imposed (daily penalties would continue to accrue but would not be collected during the time that a penalty is subject to the dispute resolution process); 

• Require completion of any independent IDR within 90 days of the notice of a penalty; 

• Provide for the collection of the penalties upon the earlier of: 1) completion of an independent IDR, or 2) 90 days after notice of the imposition of the penalty.

• Establish that when a facility is successful in a formal appeal, the applicable portion of any penalty amount being held in escrow will be returned to the facility with interest;

• Establish new authority for CMS to reduce a penalty it imposes by 50 percent (based on criteria outlined by the Affordable Care Act) when CMS determines that a facility has self-reported and promptly corrected its noncompliance, and waived its right to a hearing;

• Provide that a portion of the CMP attributable to Medicare, which is currently conveyed to the U.S. Treasury, may instead be used for the protection or benefit of nursing home residents.