CMS preparing rules for nursing home staff fines, home personal care oversight

October 15, 2018

By Virgil Dickson, Modern Healthcare

The CMS is looking to increase its oversight of post-acute care settings through new civil money penalties on nursing home staff and a new verification process to confirm personal attendants actually showed up to care for seniors when they are at home.

A proposed rule in the works to implement a federal law would allow the CMS to impose enforcement actions on nursing home staff in cases of elder abuse or other illegal activities, the agency announced in a notice Friday.

The regulation being developed will outline how the CMS would impose civil money penalties, or CMPs, of up to $200,000 against nursing home staff or volunteers who fail to report reasonable suspicion of crimes. In addition, the proposed regulation would allow a two-year exclusion from federal health programs for retaliating against individuals who report.

The CMS has long had the authority to impose fines against nursing homes, however, a new rule would be needed to impose them against staff or volunteers of these facilities, it said. The agency did not reveal when it will release the proposed rule.

The announcement comes a year after HHS' Office of Inspector General released a report that found the CMS is not doing enough to ensure cases of potential abuse or neglect get reported.

A federal law allowing HHS to impose CMPs on nursing home staff and volunteers became effective in 2011. Agency officials told HHS' OIG last year that they had not taken any enforcement action under the law yet as they were waiting for the HHS Secretary to formally delegate the agency authority to do so.

CMS is also now moving forward with plans to implement a section of 2016's 21st Century Cures Act that calls for state Medicaid agencies to launch electronic visit verification systems for personal care services.

The Cures Act requires state Medicaid programs to implement these systems for personal care services such as with helping seniors bath or eat by January 2019.

Lawmakers called for the requirement mandate due to expected growth in use of personal care service as more seniors begin to seek long-term treatment while staying at home.

The agency is now collecting comments on the survey it plans to use to confirm that states are indeed putting the systems in place, according to a notice issued Friday. Comments are due Dec. 5.

Medicaid spending on personal care services hit $15 billion in 2015, up dramatically from $2.3 billion from 2012, according to a U.S. Government Accountability report issued last year.

The agency found that despite billions being spent on such services the CMS did not have a way of verifying who performed the services or if they were done at all, according to the report.