Upper Range of Penalty

10005.5 - Upper Range of Penalty (Rev. 221; Issued: 05-10-24; Effective: 05-10-24; Implemetation:05-10-24) Upper range penalty amounts are imposed for a condition-level deficiency that is IJ. The CMP upper ranges are set forth in §§488.845(b)(3)(i), (ii), and (iii) for HHA and §488.1245(b)(3)(i), (ii), and (iii) for hospice programs and will vary based on the following: a. If the IJ is cited for actual harm; b. If the IJ is cited for potential for harm; and c. If the IJ is cited for a violation of established HHA or hospice program policies and procedures Note: The following examples contain findings that could become a part of an HHA’s or hospice program’s IJ citation. Please note that the citation of IJ is only made after careful investigation of all relevant factors as detailed in Appendix Q. An IJ decision requires a determination that the situation meets all required IJ components. 1. Section 488.845(b)(3)(i) for HHAs and §488.1245(b)(3)(i) for hospice programs address CMPs for a deficiency or deficiencies that are determined to be IJ and that results in actual harm. Examples: The facility fails to report to a physician, episodes of severe hyperglycemia, resulting in ketoacidosis and hospitalization of diabetic patient; and the facility fails to timely and accurately assess a patient’s pressure ulcers, which deteriorate to Stage 4 and sepsis prior to their recognition. 2. Section 488.845(b)(3)(ii) for HHAs and §488.1245(b)(3)(ii) for hospice programs address CMPs for a deficiency or deficiencies that are determined to be IJ and that result in a potential for harm. Examples: The facility fails to intervene after patient verbalizes threats of suicide, resulting in potential for self-harm; and the facility fails to administer ordered intravenous antibiotic to patient with diagnosed infection, resulting in potential for development of sepsis. 3. Section 488.845(b)(3)(iii) for HHAs and §488.1245(b)(3)(iii) for hospice programs address per day penalties for an isolated incident of noncompliance that is in violation of the HHA’s or hospice program’s established policies and procedures. Example: One of the facility’s nurses did not follow the infection control policies and procedures when performing wound care requiring sterile technique on an immunocompromised patient. Current information on the range of CMPs and the maximum amounts is posted on the CMS website on the Quality, Safety & Oversight Group webpage at https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual- Adjustments.html The penalty in this upper range will continue until the IJ is removed and substantial compliance can be determined per the usual procedures. (See Appendix Q for IJ removal process and timelines) During the revisit survey, the SA will determine if the IJ is removed. If the IJ situation has been removed, but condition level deficiencies still exist, the penalty amount may be decreased to the middle or lower range of penalties based on the deficiency. Note: In accordance with 42 CFR 488.830(a)(2) for HHAs and 42 CFR 488.1230(c) for hospice programs, if one or more alternative sanctions are imposed as an alternative to termination, the delay in termination may not exceed 6 months from the last day of the survey identifying condition-level noncompliance.