Long-term-care facilities caught violating federal quality standards will be subject to fines of up to $10,000 a day and a variety of more minor penalties under regulations that will take effect next year.
Starting July 1, 1995, HCFA can choose to punish nursing homes by directing corrective action, requiring ad-Long-term care
ditional training of staff, denying payments for Medicare and Medicaid patients, imposing fines ranging from $50 to $10,000 a day, and even closing facilities. The new regulations were published last week in the Federal Register.
The sanctions will allow HCFA to choose a penalty to match the severity of a violation, the agency said. Previously, HCFA could only instruct long-term-care providers to correct deficiencies or kick them out of Medicare and Medicaid programs.
"A nursing home provider will be held accountable for every deficiency observed by a surveyor," said Barbara Gagel, director of HCFA's health standards and quality bureau. "What we have now is the opportunity to select the remedy that is appropriate."
State agencies inspect nursing homes an average of once a year. In 1993, 15,000 of the nation's 16,700 nursing homes had some type of violation. In most cases, however, the violations were minor and would fall under the new rule's "substantial compliance" provisions that require the nursing home to develop a correction plan or simply commit to correcting the violation.
But Howard Bedlin, a long-term-care lobbyist for the American Association of Retired Persons, characterized the substantial compliance provision as a potential loophole that nursing homes could use to evade compliance.
The American Health Care Association, which represents 11,000 long-term- and subacute-care facilities, welcomed the new rule. AHCA spokeswoman Linda Keegan said the group liked the provision of a targeted inspection program to focus on facilities that frequently violate standards.