McKnight's Long-Term Care News, March 2019, page 1, Kate Goodrich
Kate Goodrich

A long-running moratorium on monetary fines for nursing homes will expire in May, a top Centers for Medicare & Medicaid Services official testified to federal officials Wednesday.

Chief Medical Officer Kate Goodrich, M.D., told the  Senate Committee on Finance that providers will soon begin receiving civil monetary penalties in eight additional categories. CMS instituted an 18-month moratorium of enforcement penalties under Phase 2 of the Final Rules of participation in late 2017, giving nursing homes more time to comply.

Lawmakers grilled Goodrich about the moratorium earlier this week, and she assured officials the penalties will be back soon, as originally promised. She also stressed that CMS still surveyed for those deficiencies and cited SNFs that were not in compliance in those eight categories, but did not issue monetary fines.

“The moratorium was around using some of our more severe enforcement penalties, like civil monetary penalties, for just those eight items for 18 months, and instead, the enforcement remedies we put in place were more educational in nature,” she said. “Starting in May of this year, those eight items now will be subject to any of the penalties we have.”

The moratorium reflected an effort on CMS’ part to allow more time and education for providers, and address issues with the requirements. Goodrich noted that some of the Phase 2 requirements were “a little bit of a bigger lift” for facilities, and some providers, particularly in rural areas, were having a hard time getting up to speed.

F-Tags included in the moratorium were: F655 – Baseline Care Plan, F740 – Behavioral Health Services, F741 – Sufficient/Competent Direct Care/Access Staff-Behavioral Health, F758 – Psychotropic Medications related to PRN Limitations, F838 – Facility Assessment, F881 – Antibiotic Stewardship Program, F865 – QAPI Program and Plan related to the development of the QAPI Plan, and F926 – Smoking Policies.

During Wednesday’s hearing, Sen. Ron Wyden (D-OR) also grilled Goodrich about nursing homes’ preparation for disasters. A scathing report issued by the ranking member of the Senate Committee on Finance last year chastised SNFs for being underprepared to respond to hurricanes and other catastrophes.

The report offered eight recommendations, including revising safe and comfortable temperature standards and requiring nursing homes to install emergency backup generators.

Goodrich said the report’s recommendations were “commonsense” and worth adopting. Senators also expressed interest in exploring a nationwide backup generator requirement, such as one recently adopted in Florida.

Wyden also requested that CMS create a report on nursing home staffing under the new Payroll-Based Journal method, which Goodrich said would be forthcoming.