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Nursing Home Enforcement: Collection of Civil Money Penalties (OEI-06-03-00420) http://www.oig.hhs.gov/oei/reports/oei-06-03-00420.pdf
This OIG report found that as of March 2004, CMS did not fully collect 4 percent of the civil money penalties (CMPs) imposed in 2002 and collected another 8 percent well after their due dates. CMS did not take all required actions to collect 94 percent of past-due CMPs, but did take some actions beyond those required that improved collection results. Responsibilities for CMP collections are neither clearly defined nor commonly agreed upon. OIG also found that the databases used for tracking CMP collections contained inaccurate and incomplete information, causing collection errors and frustrating staff. OIG recommends that CMS provide oversight to ensure that all required actions for collecting CMPs are taken, educate CMS staff using written guidelines to clarify responsibilities for CMP collections, and ensure the accuracy of information contained in databases used for tracking CMP collections while making them easier to use. CMS concurred with OIG's recommendations. (8/05)
Department of Health and Humans Services Office of Inspector General (OIG) Report: [PDF] Nursing Home Enforcement: The Use of Civil Money Penalties (OEI-06 ...
This report documents that almost 60 percent of civil monetary penalties (CMPs) against nursing homes in 2001 and 2002 – amounting to more than $47 million – were delayed or never collected. In 70 percent of cases where CMPs were levied, the amount was reduced because the facilities waived their right to appeal; when cases were appealed, they took twice as long to collect. Of the appealed cases for which a decision was known, 74 percent resulted in reductions in the amount of the CMP.
CMS regional enforcement staff have broad discretion in the dollar amount of CMPs, and the OIG report says the amounts are well below the allowable ranges. For example, 40 percent of immediate jeopardy cases had CMPs at the bottom of the allowable range per day ($3,050), and the median CMP for actual harm was only $250 a day.
Federal Government Guidance to States on Use of CMPs
Report on Nursing Home Quality Improvement/Assurance Activities - includes some information on projects funded using CMPs.
Abstracts:
Regulation of Nursing Facilities in the United States: An Analysis of resources and Performance of State Survey Agencies, Kieran Walshe, PhD, and Charlene Harrington, PHD, The Gerontologist, Vol. 42, No. 4, 475-486. This article reports on a survey of the resources, staffing, and performance of the state survey agencies, which enforce nursing home regulations. Total state agency expenditures on nursing home regulation in 2000 were $382.2.million, which is less than one half of 1% of the total expenditures on nursing homes in the U.S. Resource levels for nursing home regulation vary by state, and most agencies report that significant funding shortfalls impact on their ability to perform their regulatory function. The study concludes that more funding, support and oversight by CMS and more effective regulatory design is needed for state survey agencies to effectively regulate nursing homes. To learn how to get a copy of the full article, go to: http://gerontologist.gerontologyjournals.org/cgi/reprint/42/4/475.
State Nursing Home Enforcement Systems, Charlene Harrington, Joseph T. Mullan, and Helen Carrillo, Journal of Health Politics, Policy and Law, Volume 29, No. 1, 43 – 73, Duke University Press, February 2004. This article reports on a survey of state agency officials and OSCAR data. The study reviewed the actions of the survey agencies and their use of sanctions on deficient nursing facilities, including imposition of CMPs. The study evaluated and compared states based on the stringency of their nursing home enforcement. The study identifies a number of predictors for the stringency of state enforcement actions, as well as barriers to effective regulation. To learn how to order a copy of this article, go to: http://dukeupress.edu/contactus/howtoorder.shtml.
The project has produced several reports which can be downloaded for free from this webpage. These materials include the full report, Funding for Innovation: A Review of State Practices with Civil Monetary Penalties, which includes details of projects in six states and findings of a survey with long term care ombudsmen and consumers. In addition, the following specific components of that report can be downloaded separately:
· Case Studies – examining a number of state activities and identifying “best practices.”
· Resource Brief – describing a survey of ombudsmen and advocates including information on their knowledge and perceptions of the use of fines, public information issues, and recommendations for changes in policies and practices. The brief also discusses current methods for informing the public about CMPs and state fines and identifies “real life” successful practices in consumer education on CMPs and state fines.
· Action Plan – relates the findings of all of the above products to help stakeholders use the information in their states to advocate for use of the monies collected to improve resident quality of life.
Scholarly materials on our study have been submitted for publication. Check this page in fall or winter 2006 for more information on our findings which will be made available once they are published.
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