Questions and Answers
If a facility is in noncompliance and IJ does NOT exist, CMS or the State may impose either a per day civil money penalty between _____ per day.
$50 - $3,000
If a facility is in noncompliance and IJ does NOT exist, CMS or the State may impose a 'per instance' civil money penalty between _____ for each deficiency.
$1,000 - $10,000
In what situations will CMS impose federal remedies and identify the survey as a 'No Opportunity to Correct'?
- IJ (scope and severity levels J, K, and L); 2. G, H, or I deficiencies that fall into Substandard Quality of Care; 3. G or above deficiencies on the current survey AND G or above deficiencies on the previous standard health or LSC survey OR G or above on any type of survey between the current survey and the last standard health or LSC survey; 4. A facility is classified as a SFF AND has a deficiency at level F or higher for the current health survey or G or higher for the current LSC survey.
Directed in-service training remedies can be imposed when the facility has deficiencies where there are ____.
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What is a plan developed by either the State or CMS that details actions the facility must take to address noncompliance?
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What is the term for the temporary appointment by CMS or the State of a substitute facility manager or administrator?
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____ will be imposed when a facility is not in substantial compliance 3 months after the last day of the survey identifying deficiencies.
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____ has the authority to deny all payment for Medicare and/or Medicaid residents.
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What factors are used to determine the use of denial of payment for all Medicare and Medicaid residents?
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What is the role of a state monitor in a facility?
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____ will be imposed when a facility has been cited with substandard quality of care deficiencies on the last 3 consecutive standard health surveys.
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____ can impose a State's ban on admissions remedy only with regard to all Medicare/Medicaid residents. Only ____ can ban admissions of private pay residents.
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The State must forward the form CMS-2567 to the facility by no later than the ____ after the last day of the survey.
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The facility must submit its plan of correction by ____.
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What are the requirements for an acceptable plan of correction?
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Surveyors will complete a mandatory onsite revisit when a facility's beginning survey finds deficiencies that constitute substandard quality of care, harm, or IJ.
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Remedies can be imposed only at certain times for specific levels of noncompliance.
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Onsite revisits can be conducted at any time for any level of noncompliance.
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If a facility is in substantial compliance, but has deficiencies that are isolated with no actual harm and potential for only minimal harm, the facility will receive ____.
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A plan of correction is NOT required for ____.
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What are the 3 expectations established by the nursing home reform regulation?
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What is the abbreviation for a survey that gathers information through resident-centered techniques on facility compliance?
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What is the definition of Abuse in the context of nursing facilities?
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What does CASPER stand for?
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What is meant by Certification of Compliance?
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What is the definition of Certification of Noncompliance?
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What denotes a Deficiency in a skilled nursing facility?
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What does DoPNA stand for?
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What does DPoC stand for?
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What defines a Dually Participating Facility?
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What is meant by Enforcement Action?
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What is an Expanded Survey?
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What is an Extended Survey?
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What does FSES stand for?
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What is IDR?
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What does IJ represent?
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What is the definition of Immediate Family?
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What does Immediate Jeopardy refer to?
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What does LSC stand for?
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What does MAC represent?
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What is Misappropriation of Resident Property?
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What does NATCEP stand for?
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What defines Neglect in a facility?
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What constitutes a New Admission?
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What is Noncompliance?
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What does NOTC mean?
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What does OTC stand for?
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What is a Partial Extended Survey?
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What is Past Noncompliance (PNC)?
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What does Per Day CMP mean?
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What is Per Instance CMP?
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What does QIES stand for?
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Who is considered a Representative in the context of nursing facilities?
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What is Self-Reported Noncompliance?
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What does SFF stand for?
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What is the State Survey Agency (SA)?
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What is the State Medicaid Agency (SMA)?
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What does Substandard Quality of Care (SQC) mean?
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What is Substantial Compliance?
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What describes a skilled nursing facility (SNF)?
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What describes a nursing facility (NF)?
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What kinds of facilities may qualify as a SNF or NF?
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How many hours a day must SNFs provide licensed nursing services?
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What are the RN coverage requirements for SNFs?
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What are the requirements for a Director of Nursing (DON)?
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What nursing requirements may be granted a waiver?
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What is the maximum number of beds per resident room?
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What is the minimum space required for multi-patient rooms?
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What is the minimum space required for a private room?
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What must be completed to certify a SNF or NF?
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When may state monitoring visits occur?
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Facilities must be subject to a standard survey no later than how long after the last day of the previous standard survey?
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The statewide average interval between standard surveys must not exceed what?
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What is the mandatory denial of payment for new admissions and termination time frame for the health portion of the standard survey?
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What is the mandatory denial of payment for new admissions and termination time frame for the life safety code portion of the standard survey?
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The State may conduct a standard or abbreviated survey within how many days of a change in ownership or management?
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What is the consequence of refusing to permit a survey team from performing an unannounced site visit?
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When are extended or partial extended surveys conducted?
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What is the time frame for conducting an extended or partial extended survey after the standard survey?
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Who must the State notify when substandard quality of care is identified?
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Facilities may not use the IDR process to delay what?
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What are the requirements for submitting a request for an IDR?
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How will the facility be notified of the availability of an IDR?
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If a facility is successful in disputing a deficiency during the IDR process, what will they receive?
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Any form CMS-2567 or plan of correction revised due to an IDR must be disclosed to whom?
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When may an independent IDR be requested?
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What is the time frame for an independent IDR following the notice of a civil money penalty?
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Independent IDRs must be completed within how many days of a facility's request?
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When may CMS collect and place imposed civil money penalties in an escrow account?
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A facility must request an independent IDR within how many days?
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What is another name for the form CMS-2567?
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For initial certification, when is the Medicare provider agreement effective?
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When IJ exists, how quickly may termination and/or temporary management be imposed?
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If the IJ is not removed, when will the provider agreement be terminated?
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If IJ exists, what is the range of civil money penalty per day?
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If IJ exists, remedies may be imposed within how many days from the notice?
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If IJ exists, what must facilities submit to verify removal?
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What will happen if a facility is still in noncompliance 6 months after the survey that determined noncompliance?
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Termination of Medicare and/or Medicaid provider agreements may be imposed within how many days from the date the facility receives notice?
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If a facility is in noncompliance, when will denial of payment for new admissions be imposed if substantial compliance is not achieved?
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Study Notes
Nursing Home Reform Regulations
- Three key expectations: substantial compliance with Medicare/Medicaid requirements and state law, prompt addressing of deficiencies, and provision of necessary care for residents’ optimal functioning.
Survey Types
- Abbreviated Standard Survey: Gathers resident-centered data on facility compliance based on complaints or changes in management.
- Expanded Survey: Conducted when substandard care is suspected, expanding scope beyond standard surveys.
Definitions and Compliance
- Abuse: Willful infliction of harm, confinement, or intimidation resulting in pain or mental anguish.
- Deficiency: Failure of a facility to meet participation requirements set by Social Security Act or federal regulations.
- Substantial Compliance: Identified deficiencies pose minimal risk to resident health or safety.
Standard and Certification Processes
- Certification of Compliance: Facility meets compliance and can participate in Medicaid/Medicare.
- Certification of Noncompliance: Facility fails to comply and cannot participate in Medicaid/Medicare.
- Dually Participating Facility: A facility with provider agreements in both Medicare and Medicaid.
Enforcement Actions
- Remedies include civil money penalties, termination of provider agreements, and denial of new admissions.
- No Opportunity to Correct (NOTC): Remedies imposed immediately upon noncompliance determination.
- Opportunity to Correct (OTC): Facility allowed to rectify deficiencies before penalties are imposed.
Resident Safety and Monitoring
- Immediate Jeopardy (IJ): Noncompliance that poses serious risk to resident health or safety, necessitating urgent action.
- Facilities subject to standard survey within 15 months; average interval between surveys not to exceed 12 months.
Special Programs and Training
- NATCEP: Nurse Aide Training and Competency Evaluation Program ensuring adequate staff training.
- Directed In-Service Training: Required when deficiencies are identified to improve care quality.
Financial Penalties
- Civil money penalties can vary per day or per instance of noncompliance.
- When IJ exists, CMS may impose daily penalties ranging from $3,050 to $10,000.
Investigative Processes
- Informal Dispute Resolution (IDR): A process allowing facilities to contest deficiencies, must be requested in writing within specified timeframe post-survey.
- Civil monetary penalties can be held in escrow during independent IDR proceedings.
Facility Requirements
- Skilled nursing facilities (SNFs) must provide 24-hour licensed nursing services.
- Minimum space requirements: private rooms must be 100 sq ft, multi-patient rooms must be 80 sq ft per bed, maximum of 4 beds per room.
Administrator and Staffing
- Directors of Nursing (DON) must be registered nurses and work full-time.
- Waivers for staffing requirements may be granted under specific conditions.
Compliance Consequences
- Facilities failing to address deficiencies within 6 months face termination of Medicare/Medicaid agreements.
- New admissions cannot occur if a facility is under denial of payment for noncompliance.
Additional Notes
- Facilities must inform the ombudsman of any IDR process changes post-revision.
- State monitoring visits ensure compliance and resident welfare, particularly during changes in ownership or after serious incidents.
Knowledge Gaps and Education
- Knowledge gaps arise from deficiencies in practice standards, staff competencies, or minimum participation requirements.
- Education is considered a viable solution to address noncompliance issues.
Direct Plan of Correction
- Developed by the State or CMS, or a temporary manager.
- Outlines specific actions to rectify noncompliance and address underlying root causes.
Temporary Management
- Involves CMS or State appointing a temporary manager with broad authority.
- Responsibilities include staff management, financial obligations, and procedural alterations to fix operational deficiencies.
Denial of Payment for New Admissions
- Mandatory denial imposed when a facility remains noncompliant after three months post-survey or has shown substandard care on the last three consecutive surveys.
CMS Authority
- CMS holds the power to deny payments for Medicare and/or Medicaid residents.
Factors for Denial of Payment for All Residents
- Determined by seriousness of survey findings, facility's noncompliance history, and effectiveness of previously attempted remedies.
State Monitoring
- Involves oversight of deficiency correction by a state monitor to prevent resident harm.
- Implemented when harm occurs or is potentially likely.
State Ban on Admissions
- CMS can enforce bans for Medicare/Medicaid residents; states can impose bans on private pay residents.
CMS-2567 Timeline
- Form must be to the facility by the 10th working day after the survey ends.
Plan of Correction Submission
- Facilities are required to submit correction plans by the 10th calendar day after receiving CMS-2567.
Requirements for an Acceptable Plan of Correction
- Must detail actions to address affected residents, identify potential impacts on others, outline measures to prevent recurrence, include monitoring plans, and specify completion dates for corrective actions.
Onsite Revisit Criteria
- Mandatory onsite revisit required if initial surveys or follow-ups reveal substandard care or immediate jeopardy.
Remedies Imposition
- Remedies can be applied at any time for any level of noncompliance.
Onsite Revisit Flexibility
- Surveys can be conducted any time as a response to any level of noncompliance.
Notice of Isolated Deficiencies
- Facilities receiving isolated deficiencies without actual harm will receive Form A, indicating minimal potential harm.
Plan of Correction Exemption
- No correction plan required for receiving a Notice of Isolated Deficiencies Which Cause No Actual Harm With the Potential for Minimal Harm (Form A).
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Test your knowledge with these flashcards based on the CMS State Operations Manual. This quiz covers key expectations and processes related to nursing home reforms and regulations. Perfect for nursing students and professionals looking to reinforce their understanding of compliance requirements.