BriggsNetNews

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Monday, September 25, 2023, CMS posted QSO-23-23-NHs with the same title as this blog.

This is a 16-page Memorandum.

Nursing homes are inspected by state surveyors for compliance with federal requirements for participation with Medicare and/or Medicaid (42 CFR 483 Subpart B). When noncompliance is identified, the Centers for Medicare and Medicaid Services (CMS) may impose a civil money penalty (CMP) to incentivize swift correction of the noncompliance, and to deter future noncompliance to protect the health and safety of residents. CMPs collected from nursing homes can be reinvested to improve the quality of care and quality of life of nursing home residents (per 42 CFR 488.433). Over the last several years, CMS has approved a wide range of CMP-funded projects to benefit residents. As the program has grown, we have seen projects grow significantly in costs and scope, causing inconsistent availability and inequity in access to these interventions throughout the country. Therefore, CMS is revising the structure of the Civil Money Penalty Reinvestment Program (CMPRP) to better define the application criteria, clarify allowable and non-allowable uses of CMP funds, and establish funding maximums.

The goals for the revised structure of the CMPRP program, include:

• Providing a detailed listing of allowable uses of CMP funding, so all applicants have a clear understanding of what types of projects will be approved;
• Funding projects to benefit residents that can be implemented in all nursing homes by a variety of different organizations (i.e., not only available through a limited number of sources that may not be accessible to all nursing homes); and
• Strive to enable all nursing homes have access to the similar, basic capabilities, reflective of those typically found in a traditional household (e.g., wireless internet access).

Allowable Uses of CMP Reinvestment Funds: The items in Attachment A are categories of projects that CMS will approve for CMP funding. There are various types of projects that can be implemented under each category by applicants from any state. CMS is also setting maximum funding amounts (i.e., caps) for these projects to ensure the costs of the projects are reasonable, and that the projects can be available to any nursing home in the country. CMS will not automatically approve the maximum amount allowable for a project. Applicants must continue to clearly demonstrate the need and reasonableness for any funds requested. CMS will consider adjusting the dollar amounts over time (e.g., for inflation). State agencies may propose additional categories of projects for CMS to evaluate approving projects under. The categories must meet the goals of the program stated above. To evaluate new categories or projects, CMS has the discretion to approve new projects to a limited number of facilities or areas to evaluate the project’s effectiveness before approving nationally.

Non-Allowable Uses of CMP Reinvestment Funds: CMS is providing an updated list of non-allowable uses of CMP funds for projects. Notably, we will no longer approve CMP funding for complex or highly-sophisticated technology projects, such as telemedicine, virtual reality, or artificial intelligence. These types of projects typically have high costs that, if adopted broadly, would quickly exceed the available amount of CMP funds, preventing access to all nursing homes and resulting in inequity. While some of these projects may have merit, we want to ensure all nursing home residents have access to basic services and beneficial projects before funding more sophisticated services in only a few nursing homes, creating inequity. These and other non-allowable uses of CMP funds are listed in Attachment B. Applications that include components of non-allowable uses of CMP funds will not be approved. Applications submitted for funding projects similar to previous applications that have been denied will also be considered non-allowable and denied. Types of projects that have been previously denied are included in the descriptions of non-allowable uses of CMP funds in Attachment B. Therefore, stakeholders should not submit applications for projects that are described in Attachment B.

This Memorandum also includes directions for new applications as well as previously submitted applications for CMP funding.

CMS encourages applicants to review all application documentation, including the Frequently Ask Questions Documents on the CMP Reinvestment Resources file weblink: https://www.cms.gov/medicare/provider-enrollment-andcertification/surveycertificationgeninfo/downloads/cmp-reinvestment-application-resources.zip  prior to submitting an application.

CMS will upload the revised allowable and non-allowable resources to the Allowable and Non-Allowable Uses of CMP funds weblink: https://www.cms.gov/files/zip/allowable-and-nonallowable-uses-cmp-funds.zip on the CMPRP webpage: https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-generalinformation/civil-money-penalty-reinvestment-program.

Resources to Improve Quality of Care: Check out CMS’s new Quality in Focus interactive video series. The series of 10–15 minute videos are tailored to provider types and aim to reduce the deficiencies most commonly cited during the CMS survey process, like infection control and accident prevention. Reducing these common deficiencies increases the quality of care for people with Medicare and Medicaid.

Learn to:

• Understand surveyor evaluation criteria
• Recognize deficiencies
• Incorporate solutions into your facility’s standards of care

See the Quality, Safety, & Education Portal Training Catalog, and select Quality in Focus.