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Elimination of Opportunity to Correct Before Federal Sanctions Are Implemented

PDF Version of BQA 00-002 (PDF, 9 KB)

Date: January 3, 2000 DSL-BQA-00-002

To: Nursing Homes NH 1

From: La Vern Woodford, Chief, Resident Care Review Section

cc: Susan Schroeder, Director, Bureau of Quality Assurance

Effective with surveys completed on or after January 14, 2000, the federal Health Care Financing Administration (HCFA) has instructed states to implement, or recommend to HCFA, immediate sanctions if certain criteria are met. Nursing homes that will be subject to immediate sanctions and which will not have an opportunity to correct before we implement or recommend federal sanctions are nursing homes that:

  • have one or more federal deficiencies alleging actual harm (grid level of G or above) at the present survey; and

  • had one or more federal deficiencies at a grid level of G or above at the last certification survey or any survey in-between the last certification survey and the present survey.

In the past, most nursing homes that were in substantial compliance with the federal nursing home regulations at the start of a survey had an opportunity to correct any deficiencies that the Bureau of Quality Assurance (BQA) cited. In these cases, BQA, or HCFA, did not impose a federal sanction unless deficiencies were found at a revisit. The only exceptions were those rare cases where immediate jeopardy was cited during the survey or where the facility had consecutive surveys with substandard quality of care. Effective with this change, any nursing home that has a deficiency at a grid level of G or above at the present survey and had a prior deficiency at G or above (issued at the last re-certification survey or later) can expect an immediate federal sanction. In most cases, this will be a civil money penalty. The sanction will continue until the nursing home comes into substantial compliance with all federal nursing home regulations.

Federal citations at a level G or higher that are issued prior to the last recertification survey do not count toward denying a facility an opportunity to correct.

HCFA has implemented this change in response to testimony before the United States Senate that past enforcement efforts did not go far enough in preventing repeated non-compliance or in ensuring the health and safety of nursing home residents.

If you have questions, please contact the Regional Field Operations Director assigned to your facility. Their names and phone numbers are listed below [via the regional offices].

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