As nursing home providers are well aware, the Centers for Medicare & Medicaid Services (CMS) may impose civil money penalties (CMPs) for a nursing home’s failure to comply with the Medicare Conditions of Participation. What many providers (and vendors of nursing home services) may not know, however, is that CMP collections are available through grants to fund activities that benefit nursing home residents. Recent reports show millions of dollars in unused funds due, in part, to a lack of applicants.
CMP Fund Grant Program
CMP fund grants are available on a state-by-state basis, with CMS oversight. Any organization, association, or university may apply for grant funds. The application process for each state differs, so a party interested in grant funding should reach out to the applicable state agency (for instance, in Georgia, the Georgia Department of Community Health) for application procedures, i.e., timeframes for submission and acceptance of applications.
CMP collections may only be used for certain projects that benefit nursing home residents. For example, grant projects may provide:
- Assistance in supporting and protecting residents of a nursing home that closes or is decertified;
- Time-limited expenses incurred in the relocation process to home and community-based settings or other facilities when a facility is closed or downsized;
- Projects that support resident and family councils and other consumer involvement in assuring quality care in facilities;
- Facility improvement initiatives;
- Development and maintenance of temporary management or receivership capability; and
- Expenses incurred by a State related to CMP uses (i.e., administrative expenses related to monitoring and evaluating a CMP project).
CMP funds may not be used for purposes that are prohibited by law, regulation, or CMS policy, i.e., projects disapproved by CMS, capital expenses of a facility, and long-term projects (greater than 3 years). In addition, CMP funds cannot be used to benefit residents of assisted living facilities, hospitals, adult day health care, etc.
Applicants are not limited to one state and may obtain grants in several states. For example, one project participating in the CMP fund grant program – “It’s Never Too Late (IN2L),” which included a proposal to fund adaptive computer technology system – has received grants in Kentucky, Mississippi, North Carolina, Louisiana, Iowa, Colorado, and Idaho (as of 2017), including multiple grants within those states.
States Have an Abundance of Funds, Not Enough Applicants
States have an abundance of CMP funds, but not enough applicants. Mississippi reports that for Fiscal Year 2019, it has over $13 million in CMP collections, with only $1.8 million committed to projects and $1.4 million to remain in reserves. That leaves over $10 million in available funding in Mississippi. The State of Tennessee had, as of March 2018, over $29 million in CMP collections, with only 6 projects (and only $815,340) committed to those projects. The Tennessee Department of Health states that one of its primary goals is to “[i]ncrease the number and quality of proposals with high [likelihood] of CMS approval by the year 2021.”
The U.S. Department of Health and Human Services, Office of Inspector General (OIG) conducts audits to determine whether states are complying with their obligation to issue CMP fund grants. In a report dated February 2019, the OIG faulted Michigan for not spending enough of its CMP collections during the period of 2014-2016. According to the OIG’s report, Michigan only expended two-thirds of its available CMP collections.
Michigan distributed the CMP funds for a variety of allowable activities, including support for long-term-care ombudsman services, services to skilled nursing facility residents, and development and creation of quality assurance performance improvement training materials. However, Michigan did not receive a sufficient number of applications to support the expenditure of funds on hand, and many of the applications addressed activities already covered under the Medicaid program. Additionally, Michigan was unable to increase awareness of funds availability and attract new applications. As a result, residents and facilities were potentially underserved because of the limited number of services that were approved and supported with CMP collections. Michigan is currently doing a quality improvement review of its system to improve its outreach and marketing of the CMP funds.
In May of 2017, the OIG also faulted the State of Minnesota for failing to grant enough CMP funds.
States have an abundance of funds available to use for the betterment of nursing homes but, in many cases, not enough applicants.