Current through Register Vol. 41, No. 3, September 23, 2024
A. Mandatory termination. As set forth by
42 CFR
488.408(1995), the
Commonwealth shall (i) impose temporary management on the nursing facility;
(ii) terminate the nursing facility's provider agreement; or (iii) impose both
of these remedies when there are one or more deficiencies that constitute
immediate jeopardy to resident health or safety. In addition, the Commonwealth
shall terminate the nursing facility's provider agreement when the nursing
facility fails to relinquish control to the temporary manager, or in situations
when a facility's deficiencies do not pose immediate jeopardy, if the nursing
facility does not meet the eligibility criteria for continuation of payment set
forth in 42 CFR
488.412(a) (1995).
B. The Commonwealth shall have the authority
to terminate a nursing facility's provider agreement if such nursing facility:
1. Is not in substantial compliance with the
requirements of participation, regardless of whether or not immediate jeopardy
is present; or
2. Fails to submit
an acceptable plan of correction within the timeframe specified by the
Commonwealth. For purposes of this section, substantial compliance shall be
defined as meaning a level of compliance with the requirements of participation
such that any identified deficiencies pose no greater risk to resident health
or safety than the potential for causing minimal harm.
C. Situations without immediate jeopardy. If
a nursing facility's deficiencies do not pose immediate jeopardy to residents'
health or safety, and the facility is not in substantial compliance, the
Commonwealth shall have the authority to terminate the nursing facility's
provider agreement or allow the nursing facility to continue to participate for
no longer than six months from the last day of the survey agency's survey if:
1. The survey agency finds that it is more
appropriate to impose alternative remedies than to terminate the nursing
facility's provider agreement;
2.
The Commonwealth has submitted a plan and timetable for corrective action
approved by HCFA; and
3. The
facility in the case of a Medicare skilled nursing facility or Commonwealth in
the case of a Medicaid nursing facility agrees to repay to the federal
government payments received after the last day of the survey that first
identified the deficiencies if corrective action is not taken in accordance
with the approved plan of correction.
D. Effect of termination. Termination of the
provider agreement shall end payment to the nursing facility.
E. Patient transfer. The Commonwealth shall
provide for the safe and orderly transfer of residents when the facility's
provider agreement is terminated.
F. Continuation of payments to a facility
with deficiencies. As set forth by
42 CFR
488.450:
1.
The Commonwealth shall have the authority to terminate the nursing facility's
provider agreement before the end of the correction period if the following
criteria are not met:
(i) the survey agency
finds that it is more appropriate to impose alternative remedies than to
terminate the nursing facility's provider agreement;
(ii) the Commonwealth has submitted a plan
and timetable for corrective action which has been approved by HCFA; and
(iii) the Commonwealth has agreed
to repay the federal government payments received under this provision if
corrective action is not taken in accordance with the approved plan and
timetable for corrective action.
2. Cessation of payments. If termination is
not sought, either by itself or with another remedy or remedies, or any of the
criteria of subdivision 1 of this subsection are not met or agreed to by either
the facility or the Commonwealth, the facility or the Commonwealth shall
receive no federal Medicaid payments, as applicable, from the last day of the
survey.
3. Period of continued
payments. If the criteria of subdivision 1 of this subsection are met, HCFA may
continue payments to the Commonwealth for a Medicaid facility with
noncompliance that does not constitute immediate jeopardy for up to six months
from the last day of the survey. If the facility does not achieve substantial
compliance by the end of this six-month period, the Commonwealth shall have the
authority to terminate its provider agreement.
Statutory Authority
§ 32.1-325 of the Code of Virginia.
