States can now impose immediate fines on nursing homes with a record of causing harm to residents, according to new rules sent out by HCFA last week to state survey agencies.
The rules constitute a blow for the nursing home industry, which has pushed for a reduction in surveys for homes with good records and an increase in surveys for poor performers.
HCFA's crackdown is part of a series of steps the agency is taking to combat poor-quality care in nursing homes.
Other agencies are getting into the new enforcement spirit as well.
The U.S. Justice Department and other agencies have held a series of regional meetings designed to encourage participation of local law enforcement and attorneys general in prosecuting nursing home abuse and neglect.
The meetings were held in California, Iowa and Pennsylvania, and a fourth is scheduled for South Carolina next year.
Stepped-up survey efforts under HCFA's new rules will be funded through $50 million earmarked for quality enforcement, HCFA said. The agency also has diverted $4 million from other programs to support the project.
Betty Simmons, spokeswoman for the Pennsylvania Association of Non-Profit Homes for the Aging, said the punitive regulatory climate holds nursing homes back.
"Nursing facilities are so heavily regulated that (they) are afraid to be innovative," she said.
HCFA also has added facility-specific records of bed-sore prevalence, among other quality indicators, to its online nursing home information site. Some 15% of all nursing homes could be subject to the new immediate-sanctions rule, which kicks in when a nursing home has two consecutive citations for "actual, isolated harm" to residents.
Nursing homes operators complain that the new rules will result in fines for trivial or technical violations of regulations.
Robert Greenwood, spokesman for the American Association of Homes and Services for the Aging, said one Kansas operator reported receiving an actual-harm citation for making a mathematical error that resulted in a $3.82 imbalance on a resident's account.