Penalties paid by nursing homes that violate Medicare regulations could be redirected to fund advanced training programs for direct-care workers, if regulations proposed by the Centers for Medicare and Medicaid Services (CMS) are implemented.
These are the first regulations to be proposed as part of the nursing home transparency provisions of the Affordable Care Act.
CMS is requesting comments by August 11 on this, and other, proposed regulations related to civil monetary penalties (CMPs). Nursing homes pay CMPs when they violate Medicare and/or Medicaid quality-of-care requirements.
Instructions for filing comments can be found in the July 12 edition of the Federal Register (pdf).
Distributing CMP Funds
Monetary penalties collected from facilities that violate Medicaid regulations go into government coffers to be spent on programs that “directly benefit facility residents.” Since 2002, direct-care worker training programs have been included within that category.
CMP funds derived from Medicare violations, meanwhile, are redirected to the U.S. Treasury, and are added to general revenues.
CMS is now proposing to use half of the CMP money garnered from Medicare penalties to support activities that benefit facility residents.
“The Affordable Care Act’s provisions are a welcome recognition that all CMPs ought to be put back into programs to benefit the residents,” said Hollis Turnham, PHI Midwest director. “I’m hopeful that once the regulations are finalized, CMS will have new resources to serve residents, including enhancing the skills of frontline staff.”
Past Uses of CMP Funds
In the past, funds from nursing home Medicaid violations have been used to fund many different kinds of programs pertaining to direct-care workers.
For example, Indiana has used CMP funds to pay for advanced dementia training. Meanwhile, North Carolina funded instruction for PHI Coaching SupervisionSM training with CMP money. And, a program in Kansas helped subsidize a skill-improvement training for direct-care workers there.
Other Proposals
CMS has issued several other proposals on how to modify the CMP collection system:
- CMP funds will be placed in an escrow account if the facility decides to formally appeal the penalty.
- An independent informal dispute resolution process will be created to foster greater transparency in the appeal process.
- Facilities that self-report violations and quickly work to correct them can see a reduction in their CMP of up to 50 percent.
– by Matthew Ozga
Thanks for this valuable posting on the use of medicare nursing home penalties to fund direct care training. My organization, the Long Term Care Coalition (LTCCC), has conducted substantial research on the levying and use of CMPs nationwide and is focused on improving the use of these funds by the states so that they are used to support projects and activities that improve resident care and quality of life in innovative ways. Certainly, direct care worker training could be a good use of the funds.
Below is LTCCC’s website page dedicated to CMPs. It includes tools for stakeholders to work on the use of CMPs in their states. Currently we are working with consumer-oriented stakeholders in four states to help them have a strong role in their states’ uses of the funds. We will be issuing a report on this in the fall which, we hope, will be helpful to consumers and other stakeholder to improve transparency and have a greater role in their states’ levying and use of these monies.
Re. the proposed regs from CMS, we were really thrilled to see them now proposing to allocate CMPs from Medicare, and not just Medicaid; this is a recommendation that we made to CMS a few years ago.
Sincerely,
Richard Mollot
http://www.nursinghome411.org/CMPProject/index.php
Don’t forget about home care workers and their need for training and support in thye same areas as those needed by facility staff. I realize the penalties are for facility based services yet health care reform also addresses increasing community services as well as making institutional services better.