By Kelly J. Rooney, J.D., M.P.H.
During a review by the Office of Inspector General (OIG) of the civil money penalty (CMP) collections by the Minnesota Department of Human Resources, the OIG found that the state agency reimbursed nursing facilities only about 20 percent of the CMPs collected. A small amount of expenditures made by the facilities with these CMP collection funds returned to them were not allowable. The state agency, as a result, will make improvements to its use of the returned funds (OIG Report, A-05-16-00017, May 26, 2017.).
CMP collections. CMPs may be imposed on a facility for failing to comply with Medicare and Medicaid participation requirements pursuant to Soc. Sec. Act secs. 1819(h) and 1919(h). CMPs may be imposed for each day of noncompliance (the imposition of penalties was amended by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) sec. 6111), or even for past instances of noncompliance where there is compliance at the time of the survey. In Minnesota, the Medicaid share of the CMPs collected from facilities is returned to the state agency. Facilities receive funds for proposals that protect or improve the quality of care for residents. But if CMS finds the funds are not spent appropriately or if the state fails to make use of the funds, future disbursements may be withheld.
Use of CMP funds. Minnesota included $591,596 in CMS collections reported on the CMS Certification and Survey Provider Enhanced Reports (CASPERs) during fiscal years 2013 through 2015. The OIG found, however, that nursing facilities were only reimbursed $113,697 for expenditures on proposals to protect or improve the quality of care for residents during that time. The OIG noted, "there was limited guidance on using collections before our audit period," and "residents and facilities were potentially underserved" because of the small level of disbursement of the CMP funds. There were two facilities that received CMP funds (totaling $5,000) for nursing home staff and supply expenses, which was not allowed under federal regulations as CMP funds are not intended to pay for functions that are already the responsibility of the facility.
Corrective actions. The OIG recommended that the state agency work with facilities to fully utilize the CMP funds collected. In response, the commissioner of the state agency noted that the state concurred with the findings and recommendations. The state agency is currently working on proposals to (1) help patients with dementia through music and memory programming; (2) provide statewide training to help providers achieve resident-centered goals under the new 2016 CMS requirements; and (3) develop training for providers to address sexual abuse.
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