Factors to be Considered in Selecting Sanctions/Remedies

10004.1 - Factors to be Considered in Selecting Sanctions/Remedies (Rev. 221; Issued: 05-10-24; Effective: 05-10-24; Implemetation:05-10-24) When making sanction/remedy choices, the CMS Location should consider the extent to which the noncompliance is the result of a one-time mistake, larger systemic concerns, or an action of disregard for patient health and safety. CMS bases its choice of sanction(s)/remedy(ies) on consideration of one or more factors that include, but are not limited to, the following: • The extent to which the deficiencies pose IJ to patient health and safety. • The nature, incidence, manner, degree, and duration of the deficiencies or noncompliance. • The presence of repeat deficiencies, the HHA's or hospice program’s overall compliance history and any history of repeat deficiencies at either the parent or branch or multiple locations. • The extent to which the deficiencies are directly related to a failure to provide quality patient care. • The extent to which the HHA or hospice program is part of a larger organization with performance problems. • An indication of any system-wide failure to provide quality care. In addition, CMS reviews other factors including, but not limited to, the history of the HHA’s or hospice program’s compliance with the CoPs, specifically with reference to the cited deficiencies. Once a sanction/remedy is imposed, it becomes effective as of the date specified in the notice letter for the sanction/remedy being imposed. All sanctions/remedies remain in effect and continue until the facility has demonstrated and is determined to be in substantial compliance with all CoPs. The summary table below gives a high-level overview of the available sanctions/remedies and factors to consider for selection. Each of these are discussed in greater detail throughout the rest of this chapter. Available Sanction/Remedies Factors to Consider for Selection For All Sanctions/Remedies • The extent to which the deficiencies pose IJ to patient health and safety. • The nature, incidence, manner, degree, and duration of the deficiencies or noncompliance. • The presence of repeat deficiencies, the hospice program's overall compliance history and any history of repeat deficiencies at either the parent hospice program or any of its multiple locations. • The extent to which the deficiencies are directly related to a failure to provide quality patient care. • The extent to which the hospice program is part of a larger organization with performance problems. • An indication of any system-wide failure to provide quality care. Civil Money Penalty (CMP)* When repeat deficiencies exist. • Upper range of CMPs for IJ situations. • Middle range of CMPs for noncompliance that is directly related to poor quality patient care outcomes (non-IJ). • Lower range of CMPs for noncompliance that is related predominately to structure or process-oriented conditions. Suspension of payment for all new admissions (SPNA)* When condition-level deficiencies relate to poor patient care outcomes. Temporary When failure to comply with the CoPs is directly related to Summary Table of Available Sanctions/Remedies for HHAs & Hospice Programs The following sections describe each possible alternative sanction or enforcement remedy and procedures for imposing them. In addition, the CMS Location and SA follow the procedures in Chapter 3 of the SOM if an adverse action is likely to be initiated against a Medicare participating provider.