Long Term Care Civil Money Penalty (CMP) Analytic Tool

Introduction

CMS locations have a variety of enforcement remedies available to address a facility's noncompliance. These remedies include civil money penalties, denial of payment for all individuals, discretionary denial of payment for new admissions, mandatory denial of payment (new admissions 3-months), directed in-service training, directed plan of correction, discretionary termination, mandatory termination, state monitoring, temporary management, transfer of residents, and transfer of residents/closure of facility (42 CFR 488.404). Not all situations require the same remedies. The CMS location should use the enforcement remedy most appropriate, considering the level/severity of harm to the resident, the context behind the facility's noncompliance, and the type of remedy to encourage a swift return to substantial compliance for a sustained period of time, thereby preventing future noncompliance.

All CMS locations are required to use the following CMP Analytic Tool and Instructions (opens in a new window): (1) to choose the appropriate type of CMP to be imposed; and (2) to calculate the CMP amount, when the CMS location determines that a CMP is an appropriate remedy to impose. CMS completes all pertinent sections of the tool. The CMP Analytic Tool steps and instructions are also available in the CMP Analytic Tool User's Guide (PDF). Though remedies are usually imposed on Level 3 and Level 4 deficiencies, depending upon the circumstances, CMS locations may impose CMPs for Level 2 deficiencies based on the factors listed in 42 CFR 488.404 and § 488.438(f).

Note: Use a separate calculation for each Life Safety Code (LSC)/Emergency Preparedness (EP), Health Survey, or any new or changed CMP within a noncompliance cycle. For factors that may increase the CMP (e.g., culpability, facility history of noncompliance, etc.), calculate these adjustment factors only once per noncompliance cycle. Apply the additional dollar amounts from these factors to a single survey within each noncompliance cycle, unless otherwise instructed. Always use the tool and User's Guide at this site (save in your bookmarks/favorites) for the most current version. Required fields are marked with an asterisk.*

Select the Calculation Type

Calculation Type:

Select "Final" if in compliance or terminated.

Enter the Case Information

Enter full name (first and last name).

Enter the date in mm/dd/yyyy format.

Select the CMP Type (Per Day or Per Instance)

Reference: Section 1819(h)(2)(B)(ii) of the Social Security Act; 42 CFR 488.404 and § 488.438.

For each instance of noncompliance where a CMP will be imposed, select only one CMP Type - Per Instance or Per Day

CMP Type:

For each instance where a CMP will be imposed for a facility, select only one CMP Type to be used: Per Day or Per Instance.

Select the CMP Start and End Dates (Only for Per Day CMPs)

Per Day CMP Start Date - The start date for Per Day CMPs is the survey start date or may be imposed on the earliest date on which facility staff engaged in the deficient practices related to the tag driving the CMP.

Per Day CMP End Date - Per Day CMPs should end the day before the date substantial compliance is achieved or the facility's termination effective date. For IJs that last only one day, impose the IJ-level CMP for that day. For IJs lasting more than one day, do not impose the IJ level CMP on the day the IJ was removed.

Enter the date in mm/dd/yyyy format.

Enter the date in mm/dd/yyyy format. The CMP End Date is required for Final Calculations.

Select the CMP Base Amount

Reference: 42 CFR 488.404(b).

Select the highest S/S level for the base Calculated CMP Amount.

Calculated CMP Amount: $

Is There a History of Facility Noncompliance?

Reference: 42 CFR 488.438(f)(1).

If a facility has had any deficiencies cited at a S/S of "G" or above on any survey (standard, complaint, or revisit) conducted in the past three (3) calendar years, add an amount indicated below based on the S/S pattern/trend of a facility's noncompliance history.

Select the amount to add to the Calculated CMP Amount.

Calculated CMP Amount: $

Are There Repeated Deficiencies?

Reference: 42 CFR 488.438(d)(2-3).

Increase the CMP penalty amount for any repeated deficiencies for which a CMP penalty was previously imposed. "Repeated Deficiencies" are deficiencies in the same regulatory grouping of requirements cited on or since the last standard survey for which a CMP was previously imposed, subsequently corrected, and found again at the next survey. This includes any deficiencies cited on an intervening abbreviated standard survey for which a CMP was previously imposed since the last standard survey.

Select the amount to add to the Calculated CMP Amount based on the highest S/S level of the repeat deficiencies.

Calculated CMP Amount: $

Are There Multiple Deficiencies?

Reference: 42 CFR 488.404(c)(1).

Survey findings that include multiple deficiencies can indicate a systemic problem related to the noncompliance, as opposed to a survey that identifies a singular or a few incidents of noncompliance. For surveys with seven (7) or more deficiencies, add an amount between the ranges indicated below.

Select the amount to add to the Calculated CMP Amount based on the guidance above.

Calculated CMP Amount: $

Is Facility Culpability a Factor?

Reference: 42 CFR 488.438(f)(4).

Add an amount indicated below if culpability is a factor above the base level of noncompliance, and is evidenced in the Form CMS-2567. Culpability as defined in the regulation refers to situations that include, but are not limited to, neglect, indifference, or disregard for resident care, comfort, or safety.

Select the amount to add to the Calculated CMP Amount based on the highest S/S level cited.

Calculated CMP Amount: $

Is an Additional Adjustment to the Calculated CMP Amount Necessary?

The Calculated CMP Amount may be adjusted by no more than 35%. If an Adjusted Calculated CMP Amount is used, provide a rationale below. If the CMS location believes that the Calculated CMP Amount should be adjusted by more than 35%, they must consult with and obtain prior approval from the Survey and Operations Group leadership before making any further adjustment using this tool.

Note: The calculated CMP must remain within the applicable regulatory range and cannot be reduced below the regulatory minimum (e.g., the minimum for an IJ-level S/S J CMP).

Select a Percentage to Adjust the Calculated CMP Amount:

Enter a dollar amount (no cents).

Adjusted Calculated CMP Amount Rationale:

Adjusted Calculated CMP Amount: $

Does the Calculated CMP Amount or Adjusted Calculated CMP Amount Exceed the Maximum Regulatory Amount?

Select the highest permissible CMP amount.

Reduced Calculated CMP Amount: $

Determine the Final Calculated CMP Amount

The Final Calculated CMP Amount is determined using one of the following:

Final Calculated CMP Amount, Per Day: The above amount multiplied by the Total CMP Days, less any Reduction.

Final Calculated CMP Amount, Per Instance: The above amount, less any Reduction.

Reduction Applied to Final Calculated CMP Amount:

Final Calculated CMP Amount: $

Enter Any Additional Case-Related Information (Optional)

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