On June 3, 2016, the Centers for Medicare and Medicaid Services (“CMS”) issued its report entitled Nursing Home Enforcement Reports Through December 31, 2014 (“Report”). The Nursing Home Enforcement Reports analyzed in the Report covered the years 2006 through 2014 and provide general information regarding enforcement actions taken by CMS Regional Offices or State Survey Agencies when a nursing home is not in compliance with Medicare and/or Medicaid requirements at 42 C.F.R Part 483.
CMS is divided into ten Regional Offices for survey, certification, and enforcement of participating nursing homes. Each of the 50 U.S. states, Puerto Rico, and the District of Columbia has an agency that conducts on-site surveys on behalf of CMS to determine whether nursing homes are compliant with federal requirements. Surveys are conducted on a 9 to 15 month cycle, with a statewide average of 12 months between surveys.
CMS enforcement reports show the percent of providers with remedies in effect (rather than imposed) and detail civil monetary penalties by region, as well as the frequency of per day and per instance civil monetary penalties in effect. There is additional data on the number of facilities by region with the following enforcement remedies: denial of payment; discretionary and mandatory denial of payment for new admissions; directed in service training; directed plan of correction; termination; state monitoring; temporary management; transfer of residents; and facility closure.
The Report found that between 1996 and 2008, the average number of deficiencies cited per survey increased from 5.1 to 7.1, an increase of 37%. Within the same period, there was a large increase in average deficiencies cited between 1997 and 2000, during which the average number of deficiencies increased from 4.9 to 6.3. The average number of deficiencies decreased slightly between 2000 and 2003, but then increased sharply in 2005 and 2006. There was little change in average deficiencies cited between 2006 and 2008.
Enforcement Trends Following The Recession
The recession began in December 2007 and officially ended in June 2009. The recession-based constraints affecting State Survey Agencies (widespread reports of layoffs, furloughs, hiring freezes, and other measures that limited State Survey Agency oversight capacity) correlate with lower deficiency citation rates for the post-2009 period. Lower deficiency citation rates led to fewer opportunities for enforcement and therefore fewer enforcement actions imposed against a noncompliant facility and a notable decline in actual harm and immediate jeopardy level citations. The decline resulted in decreased enforcement activity because most enforcement actions are taken in response to deficiency findings at the actual harm and immediate jeopardy levels.
If you or a loved one suffered injuries (or worse) while a resident of a nursing home in the United States due to nursing home neglect, nursing home negligence, nursing home abuse, or resident on resident abuse, you should promptly contact a local nursing home claim attorney in your U.S. state who may investigate your nursing home claim for you and file a nursing home case on your behalf, if appropriate.
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