Accrual and Duration Examples

10005.16 - Accrual and Duration Examples (Rev. 221; Issued: 05-10-24; Effective: 05-10-24; Implemetation:05-10-24) a. Revisit Survey Identifies New Noncompliance and Same Data Tag is Selected - If the same data tag is selected to identify noncompliance, the State (or CMS Location) could choose to utilize either the per instance or per day CMP. It would not matter whether the same data tag was selected to identify the new noncompliance. The issue is whether noncompliance is present and whether the deficient practice rises to a level that will support selecting a CMP as a sanction. For example, noncompliance was identified at HHA Tag G406 (Condition of participation: Patient rights) during the original survey. During the revisit survey, a different problem dealing with the patient rights of three patients was cited at Tag G406. The per instance or per day CMP would be selected for the noncompliance identified at Tag G406. If the per instance civil money penalty was used, the amount of the CMP might be influenced by factors relating to the violations of patient rights. However, only one per instance CMP would be appropriate. It would not be appropriate to assign a separate CMP for each of the violations related to patient rights (findings) identified at Tag G406. b. Revisit Survey Identifies New Noncompliance and a Different Data Tag is Selected - If a revisit identifies new deficiencies at a different data tag, either a per instance or per day CMP could be selected as a sanction. c. Noncompliance - IJ Does Not Exist (Per Day)- For noncompliance that does not pose IJ, the per day CMP is imposed for the days of noncompliance, i.e., from the day the penalty starts (and this may start accruing as early as the beginning of the last day of the survey that determines the HHA or hospice program was out of compliance), until the HHA or hospice program achieves substantial compliance, or the provider agreement is terminated. However, if the HHA or hospice program has not achieved substantial compliance at the end of 6 months from the last day of the original survey, the CMS Location terminates the provider agreement. The accrual of the CMP stops on the date that the provider agreement is terminated. d. Noncompliance - IJ Does Not Exist (Per Instance)- For noncompliance that does not pose IJ, the per instance CMP is imposed for the number of deficiencies during a survey for which the per instance CMP is determined to be an appropriate sanction. For example, HHA Tag G510 (Condition of participation: Comprehensive assessment of patients) and HHA Tag G370 were cited on a survey. A per instance CMP of $2,000 is imposed for Tag G370 and a per instance CMP of $8,000 is imposed for Tag G510. No civil money penalty could then be imposed for additional deficiencies because the total “per instance CMP” may not exceed $10,000 as adjusted annually for each day of noncompliance. e. Noncompliance - IJ Exists - For noncompliance that poses IJ, CMS must terminate the provider agreement within 23 calendar days after the last day of the survey that identified the IJ if the IJ is not removed. The accrual of the per day CMP stops on the date that the provider achieves substantial compliance, or the provider agreement is terminated.