Sanctions for ICFs-IID - or Nonimmediate Jeopardy

3006.1 - Sanctions for ICFs-IID - or Nonimmediate Jeopardy (Rev. 92, Issued, 11-22-13, Effective: 11-22-13, Implementation: 11-22-13) 3006.1A - General (Rev. 92, Issued, 11-22-13, Effective: 11-22-13, Implementation: 11-22-13) The Balanced Budget Act (BBA) of 1997 provided the statutory authority for States to establish and impose sanctions that are additional to the already existing alternative sanction of denial of payment for new admissions, and which are alternative to termination in cases where the ICF/IID’s deficiencies are not determined to pose immediate jeopardy to client health and safety. This strategy recognizes that deficiencies take on greater or lesser significance depending on the specific circumstances and client outcomes in each facility, and that additional enforcement options should be available so that the enforcement consequence to the facility is effective, proportionate, and appropriate to the specifics of the noncompliance. 3006.1B - Introduction (Rev. 92, Issued, 11-22-13, Effective: 11-22-13, Implementation: 11-22-13) Section 1902(i)(1)(B) of the Act, as revised by the BBA of 1997, provides that the State may establish alternative sanctions to use as enforcement remedies for deficiencies that do not constitute immediate jeopardy to client health and safety if the State can demonstrate to CMS’ satisfaction that its alternative sanctions are effective in deterring noncompliance and correcting deficiencies (see §3006.6). One or more alternative sanctions may be imposed against private or State operated ICFs/IID instead of provider agreement termination, and may also be imposed instead of or in addition to the existing alternative sanction of denial of payment for new admissions. Examples of sanctions that may be appropriate as alternative sanctions are listed in subsection C. 3006.1C - Examples of Alternative Sanctions (Rev.92, Issued, 11-22-13, Effective: 11-22-13, Implementation: 11-22-13) States should consider establishing the following alternative sanctions in their State plan for noncompliant ICFs/IID having nonimmediate jeopardy deficiencies: • Directed plan of correction; • Directed in-service training; and • State monitoring. States are not limited to establishing and using these alternative sanctions and may submit others for CMS’ approval. When the State wants to use alternative sanctions, it must be authorized to do so under its State plan by CMS (see §3006.6). In order to be approved, the State must provide specified information to indicate that the alternative sanction and its application is not inconsistent with applicable statutory and regulatory requirements, as well as demonstrate to CMS’ satisfaction that the alternative sanction is effective in deterring noncompliance and correcting deficiencies. Many States already have experience in imposing the three intermediate sanctions specified above against nursing homes (SNF/NFs) that fail to meet participation requirements. States also have experience in imposing remedies under their State licensure authority and may also wish to submit any of those to CMS for approval as alternative remedies for ICF/IID. While we want States to have the three specified intermediate sanctions listed above available for ICF/IID enforcement purposes, States are free to submit others for CMS approval as well. 3006.1D - Alternatives to Termination in Nonimmediate Jeopardy Situations (Rev. 1, 05-21-04) When the facility is found to have deficiencies that do not immediately jeopardize the health and safety of individuals served, the State may, in lieu of terminating the facility’s provider agreement: 1. Deny payment for all new Medicaid admissions to the facility after the effective date of the sanction; 2. Impose one or more of the alternative sanctions that CMS has approved; or 3. Do both (1) and (2) above. Deny payment for all new Medicaid admissions to the facility after the effective date of the sanction and impose one or more of the alternative sanctions that CMS has approved.