The Centers for Medicare & Medicaid Services should withdraw a planned civil monetary penalty expansion, a coalition of leading long-term care organizations argues in a new joint letter to the agency’s Administrator, Chiquita Brooks-LaSure.
CMS initially proposed powers to implement more CMPs “per instance and per day” in the FY25 Skilled Nursing Facilities Prospective Payment System in late March. But the coalition warned CMS that the new, layered CMPs would counterproductively divert funds away from staffing and care quality at nursing homes.
“We write to you today with significant concerns about the increased enforcement proposal … as it will not equate to better resident care, only continue to add to the workforce crisis, and displace more of our nation’s vulnerable residents,” the coalition wrote in Thursday’s letter. They later added that “the proposed revisions to the CMP enforcement mechanism are simply inconsistent with the federal statute, congressional intent, and agency authority, and should be withdrawn.”
The group comprises 12 key long-term care associations, including the American Health Care Association, LeadingAge and the American Association of Post-Acute Care Nursing. The joint letter is the latest and most unified advocacy effort the skilled nursing sector has put up in opposition to the CMP changes in the months since the CMS proposal.
“Our diverse nursing home profession agrees this is an extreme policy that will do nothing to improve quality care or benefit our residents,” Holly Harmon, senior vice president of quality, regulatory, and clinical services at AHCA told McKnight’s Long-Term Care News. “We support proper accountability, and we need to foster an oversight system that is focused on helping nursing homes improve, not piling on penalties.”
Carrot or stick
A key thrust of the coalition’s argument was that the new CMPs would be primarily punitive measures, not remedial ones.
Between more, layered CMPs and the existing delays that sometimes mean facilities can be penalized for errors from past surveys, the potential result could be chilling for providers.
“Layering CMPs and adding an excessive look back period to impose CMPs only stands to divert crucial resources away from nursing homes that need to invest in their workforce and care services,” Harmon said Tuesday.
CMS’ proposed approach is not evidence-based, the letter argues, and any penalties that go beyond what is necessary to encourage a course correction would be an overextension past the agency’s congressional mandate.
“Congress intended that nursing home enforcement actions be remedial in nature, rather than punitive,” the letter reads. “Accordingly, CMS must limit its enforcement mechanisms (including CMPs) to the level necessary to promote compliance with the participation requirements and effect remediation; CMS’s proposal to expand CMPs exceeds this threshold, is solely punitive, and contrary to agency authority as delegated by Congress.”
Sector leaders have consistently held that CMS should reprioritize its efforts away from painful CMPs and toward proactively helping providers make necessary changes.
“Rather than focusing on ways to make nursing homes do more with less, CMS should focus on what nursing homes need to actualize improvements,” wrote Jodi Eyigor, director of nursing home quality and policy at LeadingAge in a prior letter to Brooks-LaSure.
Eyigor told McKnight’s that CMS sees its role more as enforcement than quality improvement, but that a more balanced approach could achieve better results.
“During a survey situation, CMS or state surveyors come to a provider and say, ‘You’re doing this wrong’ — with no explanation of why it’s wrong or what can be done to fix it,” she said Tuesday. “Nursing homes have to try to figure out solutions on their own. To truly improve quality of care, we believe that CMS should allow surveyors to do more: at the time deficient practice is identified, they could, for instance, say: ‘I’m going to cite you for this deficient practice. Here’s why it’s a problem. Let’s talk about what you can do to correct this problem today and make sure it doesn’t happen in the future.’”
