CarinA. Marney, Esq....In the case of actual or imminent threat to resident health or...

Elena Madrid, RN BSNWashington Health Care Association303 Cleveland Avenue SE, Suite 206

Tumwater, WA 98501Tel 800 562‐6170www.whca.org

Carin A. Marney, Esq.Lane Powell

1420 Fifth Avenue, Suite 4200Seattle, WA 98101‐2375

Tel 206 223‐7000

SNF Enforcement Remedies and Timelines

WhWwhaht

•Overview of Federal SNF Enforcement and Timelines•Overview of DSHS/State Agency Enforcement• Legal Rights and Options for State and Federal Enforcement•Opportunity for questions

What we will cover in this presentation:

WhWwhaht

• New Requirements: Doubling min/max federal CMPs• New finding: WA surveys show significantly more F‐tags with higher scope/severity than other states• New trend: CMS Region X hefty per‐day penalties• New philosophy: RCS more willing to impose state civil fines on top of federal CMP

Trends and Developmentsin Civil Money Penalties

WhWwhahtFederal Timelines(AKA “The Train Story”)

WhWwhahtOut of Compliance

WhWwhaht

How do you stop the train?

Your Goal is to the STOP the Train!

WhWwhahtSubstantial Compliance

WhWwhaht

The Final Destination…it takes 6 months. According to the Social Security Act (SSA) Termination from Participation in Medicare/Medicaid.

If the train continues on the journey…

WhWwhaht

SSA requires Denial of Payment for New Admissions (DPNA) if facility fails to obtain substantial compliance in 3 months.

Key Stop Along the Way

WhWwhahtSometimes there is a “Fast Track”

WhWwhaht

Mandatory Criteria for Having No Opportunity to Correct:• “G” Level or above on the current survey as well as having deficiencies of actual harm or above on the previous standard survey.

• Facilities having deficiencies of actual harm (G) or above on the current survey, as well as having deficiencies of actual harm or above on any type of survey between the current survey and the last standard survey.

• Two level “Gs” deficiencies must be separated by a certification of compliance.

Double G

WhWwhaht

Instead of 6 months to the final destination…the facility will now reach Termination of the Provider agreement in 23 calendar days!

Immediate Jeopardy

WhWwhaht

Remove Immediate Threat to Stop the 23 Day Track and Get Back to Established Route

Immediate Jeopardy

WhWwhaht

• Required loss of program when a facility refuses to permit an unannounced visit by the SA• Deny or withdrawn when an extended or partial extended survey is conducted•When IJ is a result of substandard quality of care• CMS enforcement remedies

Nurse Aide Training and Competency Evaluation Program

WhWwhaht

• Can be delayed, no longer than 14 days following completion of the standard or abbreviated survey which identified the substandard quality of care.

Extended or Partial Extended Survey

WhWwhaht

• State Board (DoH) responsible for licensing administrator• Attending physicians for each resident who was identified as part of the Substandard Care.

Automatic Notifications following Substandard/IJ

WhWwhaht

In the case of actual or imminent threat to resident health or safety/immediate jeopardy (severity level 4 as described in WAC 388‐97‐4500), the department may require the licensee or nursing home to submit a document alleging that the imminent threat has been removed within a time frame specified by the department.

The document must specify the steps the nursing home has taken or will take to correct the imminent harm. An allegation that the imminent harm has been removed does not substitute for the plan of correction but it will become a part of the completed plan of correction.

WAC 388‐97‐4380 Plan of Correction

WhWwhaht

"Civil fine" is a civil monetary penalty assessed against a nursing home as authorized by chapters 18.51 and 74.42 RCW.

There are two types of civil fines, "per day" and "per instance."• "Per day fine"means a fine imposed for each day that a nursing home is out of compliance with a specific requirement. Per day fines are assessed in accordance with WAC 388‐97‐4580(1); and• "Per instance fine"means a fine imposed for the occurrence of a deficiency.

WAC 388‐97‐0001 Definitions

WhWwhaht

Mandatory Remedies• In accordance with RCW 18.51.060 (5)(a), the department must impose a stop placement order when the department determines that the nursing home is not in substantial compliance with applicable laws or regulations and the cited deficiency(ies):• Jeopardize the health and safety of the residents; or• Seriously limit the nursing home's capacity to provide adequate care.

• When required by RCW 18.51.060(3), the health care authority must deny payment to a nursing home that is certified to provide Medicaid services for any Medicaid‐eligible individual admitted to the nursing home. Nursing homes that are certified to provide Medicare services or both Medicare and Medicaid services may be subject to a federal denial of payment for new admissions, in accordance with federal law.

• The department must deny, suspend, revoke or refuse to renew a proposed or current licensee's nursing home license in accordance with WAC 388‐97‐4220(3).

WAC 388‐97‐4460Remedies.

WhWwhaht

When the department determines that a licensee has failed or refused to comply with the requirements under chapter 18.51, 74.39A or 74.42 RCW, or this chapter; or a Medicaid contractor has failed or refused to comply with Medicaid requirements of Title XIX of the Social Security Act or Medicaid regulations, the department, or when appropriate, the health care authority, may impose any or all of the following optional remedies:

Optional Remedies

WhWwhaht

• Stop placement;• Immediate closure of a nursing home, emergency transfer of residents or both;• Civil fines;• Appoint temporary management;• Petition the court for appointment of a receiver in accordance with

RCW 18.51.410;• License denial, revocation, suspension or nonrenewal;• Denial of payment for new Medicaid admissions;• Termination of the Medicaid provider agreement (contract);• Department on‐site monitoring as defined under WAC 388‐97‐0001; and• Reasonable conditions on a license as authorized by chapter 74.39A RCW.

Examples of conditions on a license include but are not limited to training related to the deficiency(ies); consultation in order to write an acceptable plan of correction; demonstration of ability to meet financial obligations necessary to continue operation.

WhWwhaht

The department must consider the imposition of one or more optional remedy(ies) when the nursing home has:• A history of being unable to sustain compliance;• One or more deficiencies on one inspection at severity level 2 or higher as described in WAC 388‐97‐4500;

• Been unable to provide an acceptable plan of correction after receiving assistance from the department about necessary revisions;

• One or more deficiencies cited under general administration and/or nursing services;

• One or more deficiencies related to retaliation against a resident or an employee for whistle blower activity under RCW 18.51.220, 74.34.180 or 74.39A.060 and WAC 388‐97‐1820;

• One or more deficiencies related to discrimination against a Medicare or Medicaid client under RCW 74.42.055, and Titles XVIII and XIX of the Social Security Act and Medicare and Medicaid regulations; or

• Willfully interfered with the performance of official duties by a long‐term care ombuds.

WAC 388‐97‐4480Criteria for imposing optional remedies.

WhWwhaht

The department, in its sole discretion, may consider other relevant factors when determining what optional remedy or remedies to impose in particular circumstances.•When the department imposes an optional remedy or remedies, the department will select more severe penalties for nursing homes that have deficiency(ies) that are:• Uncorrected upon revisit;• Recurring (repeated);• Pervasive; or• Present a threat to the health, safety, or welfare of the residents.


WhWwhaht

The department will consider the severity and scope of cited deficiencies in accordance with WAC 388‐97‐4500 when selecting optional remedy(ies). Such consideration will not limit the department's discretion to impose a remedy for a deficiency at a low level severity and scope.


WhWwhaht

"Severity of a deficiency"means the seriousness of the deficiency. Factors the department will consider when determining the severity of a deficiency may include, but are not limited to:•Whether harm to the resident has occurred, or could occur, including but not limited to a violation of resident's rights;• The impact of the actual or potential harm on the resident; and• The degree to which the nursing home failed to meet the resident's highest practicable physical, mental, and psychosocial well‐being as defined in WAC 388‐97‐0001.

WAC 388‐97‐4500Severity and scope of deficiencies.

WhWwhaht

Except as otherwise provided in statute, the range for a:• Per day civil fine is $50 to $3,000; and• Per instance civil fine is $1,000 to $3,000.In the event of continued noncompliance, nothing in this section must prevent the department from increasing a civil fine up to the maximum amount allowed by law.

WAC 388‐97‐4560Amount of civil fine.

WhWwhahtRevision of Civil Money Penalty (CMP) Policies and CMP Analytic Tool‐Memo #17‐37‐NH• When noncompliance exists, enforcement remedies, such as civil money penalties (CMPs), are intended to promote a swift return to substantial compliance for a sustained period of time, preventing future noncompliance.

• To increase national consistency in imposing CMPs, the Centers for Medicare & Medicaid Services (CMS) is revising the CMP analytic tool in the following areas which are further explained within this policy memorandum: • • Past Noncompliance; • • Per Instance CMP is the Default for Noncompliance Existed Before the Survey; • • Per Day CMP is the Default for Noncompliance Existing During the Survey and Beyond; • • Revisit Timing; and • • Review of High CMPs.

• This policy memo replaces S&C Memo 15‐16‐NH: The prior versions of the CMP Tool are obsolete, as of the effective date of this memo, July 17, 2017.https://www.cms.gov/Medicare/Provider‐Enrollment‐and‐Certification/SurveyCertificationGenInfo/Downloads/Survey‐and‐Cert‐Letter‐17‐37.pdf

Federal Enforcement RemediesSignificant Recent Guidance

WhWwhaht

Final Revised Policies Regarding the Immediate Imposition of Federal Remedies‐Memo # 18‐18‐N

Substantive revisions to the prior Immediate Imposition of Federal Remedies guidance include:

•When the current survey identifies Immediate Jeopardy (IJ) that does not result in serious injury, harm, impairment or death, the CMS Regional Offices may determine the most appropriate remedy; •We clarified that Past Noncompliance deficiencies (as described in §7510.1 of this chapter) are not included in the criteria for Immediate Imposition of Remedies; and, •For Special Focus Facilities (SFFs), S/S level “F” citations under tags F812, F813 or F814 are excluded from immediate imposition of remedies. •Revisions to Chapter 7 of the State Operations Manual (SOM) (Attachment): The Centers for Medicare & Medicaid Services (CMS) has revised guidance in Chapter 7 of the SOM related to the Immediate Imposition of Federal Remedies as noted in this memo and its attachment. Other sections of Chapter 7 have been revised to ensure conformity and consistency with these revisions H


https://www.cms.gov/Medicare/Provider‐Enrollment‐and‐Certification/SurveyCertificationGenInfo/Downloads/QSO18‐18‐NH.pdf

WhWwhaht

PNC deficiencies are NOT included in the criteria for Immediate Imposition of Remedies When survey identifies an IJ, that does not result in serious injury, harm, impairment or death, the CMS RO must immediately impose a remedy. Some possible may include a CMP, directed in‐service training, directed POC.


WhWwhaht

Once a remedy is imposed, it becomes effective as of the date specified in the notice letter for the remedy being imposed. All remedies remain in effect and continue until the facility has demonstrated and is determined to be in substantial compliance. Substantial compliance must be verified by SA. Substantial compliance is determined by the date on which the evidence provided by the facility supports correction of deficiencies as determined by the SA.

Effective Dates for Immediate Imposition of Federal Remedies

WhWwhaht

A facility's removal of the conditions that caused the IJ may, at CMS’s discretion, result in the rescission of the 23‐day termination. A per day CMP must be lowered when the SA has verified that the IJ has been removed but deficiencies at a lower level continue. CMS SHALL NOT rescind any other remedies imposed until the facility achieves substantial compliance or is terminated.

Effective Dates for Immediate Imposition of Federal Remedies‐For IJ Situations

WhWwhaht

• Directed plan of correction• Directed in‐service training• Civil Money Penalties• Denial of payment for new admissions (mandatory after 90 days)• Denial of all payment for Medicare/Medicaid• State monitoring• Temporary management• Termination of the provider agreement (23 or 180 days)• Transfer of residents (with/without facility closure)• Alternative or additional State remedies approved by CMS

Federal Enforcement Remedies

FEDERAL SCOPE AND SEVERITY with Sanctions

35

KEY: One of these sanctions MUST be imposed; more than one MAY be imposed.Optional sanctions, one or more of which may also be imposed.

Areas above BOLD LINE = Substandard Quality of Care in 42 C.F.R. § 483.13, 483.15, and/or 483.25. Shaded Areas = Noncompliance

Isolated Pattern WidespreadImmediate Jeopardy

(Fast Track) [Level IV]

Temporary Manager Terminate Provider Agreemento Civil Money Penalty $3,050-

$10,000 per day or $1,000 to$10,000

o Deny Payment for New Admissionso Deny all Paymento Directed PoCo State Monitoringo Directed In-services

J


$10,000 per day or $1,000 to$10,000 per instance

o Deny Payment for New Admissionso Deny all Paymento Directed PoCo State Monitoringo Directed In-services

K



o Deny Payment for New Admissionso Deny all Paymento Directed PoCo State Monitoring Directed In-services

LActual Harm

[Level III] Deny Payment for New Admissions Civil Money Penalty $50-

$3,000 per day or $1,000-$10,000 per instance

Deny all Payment Directed PoC State Monitoring Directed In-services

G

Deny Payment for New Admissions Civil Money Penalty $50-


Deny all Payment Directed PoC State Monitoring Directed In-services

H



Deny all Paymento Temporary Managero Directed PoCo State Monitoringo Directed In-services

I

Potential for More than Minimal Harm

[Level II]

Directed PoC State Monitoring Directed Inserviceso Deny Payment for New Admissionso Civil Money Penalty $50-


o Deny all PaymentD

Directed PoC State Monitoring Directed Inserviceso Deny Payment for New Admissionso Civil Money Penalty $50-


o Deny all PaymentE



Deny all Paymento Directed PoCo State Monitoringo Directed In-services

FPoten’l for Min. Harm

(Substantial Compliance) [Level I]

No Sanction

A

Plan of Correction

B

Plan of Correction

C

WhWwhaht

Per‐Instance CMPs:• Authorized for each instance that a facility is not in substantial compliance, whether or not the deficiency poses immediate jeopardy• Previously: $1,000 to $10,000

• Now: $2,063 to $20,628

Federal Civil Money Penalties:42 CFR 488.438

WhWwhaht

Daily CMPs, lower range (Category 2):• Deficiencies other than IJ that:• cause actual harm, or • have the potential for causing more than minimal harm

• Previously: $50 to $3,000

• Now: $103 to $6,188


WhWwhaht

Daily CMPs, upper range (Category 3):• Deficiencies that:• Pose immediate jeopardy to residents (IJ citations)• Are repeated after CMP was previously imposed

• Previously: $3,050 to $10,000

• Now: $6,291 to $20,628


WhWwhaht

• Budget hit• Reputational damage• Automatic 2‐year exclusion from NATCEP (CNA training program) for CMPs over $10,314 (previously $5000)• Future repeat deficiencies may trigger even harsher remedies

Implications of Large CMP

Procedural Rights Upon Receiving a Citation

Paths to pursue upon receiving citation, state and federal fines

9/26/2018 ©2018 Lane Powell PC 40

Pursuing remedies on

state enforcement

Pursuing remedies on

federal enforcement

• IDR•State administrative appeal

• Financial Hardship? • IIDR• Federal administrative appeal vs 35% reduction (50% if self reported and certain conditions are met)

Survey Process

Medicare Provider Contract

• Can be terminated if 180 days of non‐compliance

• 23 days without abating an IJ

• The Federal Interest

Your SNF License

• Can be suspended or revoked for failing to satisfy state requirements of licensure

• The State Interest

9/26/2018 ©2018 Lane Powell PC 41

State Citations

Appeal state citations and enforcement

issued under WACs

Appeal to Office of Administrative Hearings (OAH)

9/26/2018 ©2018 Lane Powell PC 42

State Citations

State Sources of Survey

RCW ch. 18.51 – Nursing Home Licensing Statute

RCW ch. 74.42 – Nursing Home Resident Care & Operating Standards Statute

RCW ch. 70.129 – Long Term Care Resident Rights Statute (Generally applies to community‐based settings, but certain parts extend to NHs)

WAC ch. 388‐97 – Nursing Homes Regulations

Information for Nursing Home Professionals – general licensing page for the Department of Social & Health Services (DSHS), Aging & Long Term Care Services Administration (ALTSA), Residential Care Services Division (RCS)

DSHS‐RCS Nursing Home Enforcement Operational Principals & Procedures

DSHS‐ALTSA “Dear Administrator” Letters

9/26/2018 ©2018 Lane Powell PC 43

State citations

• DSHS‐RCS is both the state licensing agency and the federal survey agency

• RCS may inspect nursing homes at any time for licensure compliance purposes• State inspections are conducted preoccupancy, annually for license renewal, for revisits, and for complaint investigations. WAC 388‐97‐4360

• Generally, state inspections are conducted in conjunction with federal surveys

• As a practical matter, state‐level deficiencies generally parallel the federal deficiencies, though it is possible to have state‐only deficiencies

• State deficiencies follow the federal model for scope and severity. WAC 388‐97‐4500

9/26/2018 ©2018 Lane Powell PC 44

What Are Your Legal Rights

Your SNF License• The State Interest• State Rights

Medicare Provider Contract• The Federal Interest• Federal Rights

Some Overlap

9/26/2018 ©2018 Lane Powell PC 45

DSHS LETTER

Decisions to Make When You Get State Letter (DSHS)

10 days (run concurrently)• POC• IDR

20 Days• Request for State Administrative Hearing

Do you always have a right to Administrative Hearing?• No. Tied to the enforcement penalty, not the citation.

9/26/2018 ©2018 Lane Powell PC 50

WhWwhaht

If the nursing home requests a hearing, the civil fine(s) including interest, if any, is due 20 days after:• A hearing decision ordering payment of the fine(s) becomes final in accordance with chapter 388‐02WAC;• The appeal is withdrawn;• A settlement agreement and order of dismissal is entered, unless otherwise specified in the agreement; or• An order of dismissal is entered.

WAC 388‐97‐4580Civil fine accrual and due dates and interest.

WhWwhaht

• SOD/CMS‐2567• DSHS‐RCS notice• Notice of state remedies and appeal rights• Notice of IDR rights

• CMS “intent to issue” letter• Opportunity to submit financial info; no appeal yet•May accompany notice of other federal remedies; may appeal those

• CMS CMP notice• Notice of CMP and federal appeal rights

• IIDR Notice

Post‐Survey CMP Steps

WhWwhaht

• Informal Dispute Resolution• DSHS program manager • Request within 10 days of CMS‐2567

• Independent Informal Dispute Resolution• DSHS contractor (former DSHS employee)• Request within 10 days of IIDR notice (up to 30 days post‐CMP)

• Federal Departmental Appeals Board• Administrative Law Judge (federal HHS employee)• Request OR WAIVE within 60 days of CMP notice

Federal CMP:Overlapping Appeal Options

Decisions to Make When You Get The Federal Letter (CMS)

10 days• Financial Hardship Waiver• IDR or IIDR (you might have already asked for IDR because the CMS letter came much later)

• The same 10 days…

60 days• Administrative Appeal• You will not always have an appeal right

• Waive Appeal and take the discount (35‐50%)

9/26/2018 ©2018 Lane Powell PC 54

WhWwhaht

• Automatic 35% reduction• CMS must receive waiver within 60 days• Can IIDR be completed in time?

• Payment must accompany waiver• No further ability to contest federal findings

Waiving Federal Appeal Rights

Paths to Challenge State and Federal (CMPs) Fines

State Rights

• IDR• State Administrative Appeal

Federal Rights

• Financial Hardship• IIDR• Federal Administrative Appeal

9/26/2018 ©2018 Lane Powell PC 61

Federal Administrative Hearing

Heard before an Administrative Law Judge

ALJ decision can be appealed to the Department of

Appeals Board

DAB decision can be appealed to the Federal

Court of Appeals

9/26/2018 ©2018 Lane Powell PC 62

Federal Appeal or 35% Reduction

Can seek federal appeal of the federal enforcement (CMP),

or

Waive the right to federal appeal and

obtain 35% reduction of CMP

Must make this decision within 60 days of notice of the

CMP

9/26/2018 ©2018 Lane Powell PC 63

Some Reasons to Pursue Federal Appeal

You are approaching termination of your provider agreement

with CMS

Being deprived of a revisit

Need to demonstrate an effort to exhaust your administrative

appeal

9/26/2018 ©2018 Lane Powell PC 64

Some Limitations to the Federal Appeal

Can challenge scope and severity assigned to F‐Tag where• It‘s an IJ (where it affects the CMP that CMS could collect) or•A finding of substandard quality of care that results in loss of approval of nurse aide training program. 42 CFR 498.3(b)(14)

ALJ cannot enter injunctions

Cannot review CMS procedure

Cannot review CMS’s choice of remedy

Can appeal the “certification of noncompliance leading to an enforcement remedy”

9/26/2018 ©2018 Lane Powell PC 65

State Administrative Hearings

• Related to your license•When a state agency imposes enforcement actions, the action normally will not be effective until there is an opportunity for appeal• Exception for instances where there is reasonable basis to believe that harm is imminent:• Stop placement• Summary suspension of license

• The appeal is heard within the Executive Branch itself, by an Administrative Law Judge

9/26/2018 ©2018 Lane Powell PC 66

Benefits of State Administrative Hearings

• RCS is not the final decision‐maker• For the initial hearing, Administrative Law Judges are fully independent of DSHS

• DSHS Review Judges ultimately answer to the Secretary of DSHS, but generally exercise independent judgment in individual cases

• Further review available in the courts• “Discovery” process

• Access to DSHS‐RCS documents and staff testimony• You may have strategic reason to request both appeal and IDR

• Opportunity for settlement• Could be your only option: revocation

9/26/2018 ©2018 Lane Powell PC 67

Drawbacks of State Administrative Hearings

Time• Initial hearings often set out for 6+ months• In cases with extensive discovery process, may be even longer• ~18‐month process from hearing request to decision from Superior Court

Expense

9/26/2018 ©2018 Lane Powell PC 68

Some Reasons to Request A Hearing

Your license been revoked

• If you request a hearing the revocation is stayed

Serious allegations

• Are the allegations untrue or overstated?

• Is a resident lawsuit likely? (e.g., personal injury, abuse/neglect, wrongful death)

• Will the allegations harm future marketing efforts?

Heavy enforcement remedies

• Does the penalty suit the violation?

• Is the penalty so heavy that you have little choice (revocation)?

Industry‐wide implications

• Does DSHS’s questionable interpretation of its regulation set a new, costly, and/or dangerous standard?

Keeping options open/ preserve your

rights

• You requested IDR — but what if RCS refuses to change its mind?

9/26/2018 ©2018 Lane Powell PC 69

Limits to State Appeal

Cannot address Federal Survey issues

• F‐Tags, or Federal CMPs cannot be addressed

State remedies can be appealed

• State fines• License revocation, suspension or condition

• State citations (most of which correspond with Federal F‐Tags)

9/26/2018 ©2018 Lane Powell PC 70

WhWwhaht

SEVERITY Actual or Potential Minimal HarmActual or Potential Harm

(Moderate resident impact)

Actual or Potential Harm(Serious resident impact but no immediate threat to

health & safety)

Imminent Harm or Immediate Jeopardy

(Severe resident impact)

SCOPE

INITIALCITATION

REPEAT/UNCORRECTED

INITIALCITATION

REPEAT/UNCORRECTED

INITIALCITATION

REPEAT/UNCORRECTED

INITIALCITATION

ACTIONS ACTIONS ACTIONS ACTIONS ACTIONS ACTIONS ACTIONSWidespread or

systemicPOCFine/day 750‐1000Fine/instance 1000

POCFine/day 1000‐2000Fine/instance 1000‐1500

POC stop placement termination Fine/day 1000‐

3000 Fine/instance

1000‐2000 license

revocation denial of

payments department on‐

site monitor condition of

license ****

POC stop placement termination Fine/day 2000‐3000 Fine/instance 1500‐

3000 license revocation denial of payments department on‐site

monitor condition of license ****

POCstop placementimmediate closure or emergency

resident transferFine/day 2500‐3000Fine/instance 2500‐3000 temp

management/receivership

license revocation or suspensiondenial of paymentdepartment on‐site monitorcondition on license******

POCstop placement immediate closure or emergency

resident transferFine/day 3000Fine/instance 3000temp manager/receivershiplicense revocation or suspensiondenial of paymentterminationdepartment on‐site monitorcondition on license******

POCstop placement immediate closure or emergency

resident transferFine/day 3000Fine/instance 3000temp manager/receivershiplicense revocation or suspensiondenial of paymentterminationdepartment on‐site monitorcondition on license******

Moderate or Pattern

POC Fine/day

50‐1000 Fine/instan

ce ***

POC Fine/day 750‐

1500 Fine/instance

1000 condition of

license

POC Fine/day 1000‐

3000 Fine/instance 1000‐

1500 condition of

license ****

See same list of actions (above) as actual or potential harm (moderate impact) repeat/uncorrected widespread or systemic scope Fine/day 2000‐3000 Fine/instance 1000‐2000 **** **

See same list of actions (above) as actual or potential harm (serious resident impact) initial citation widespread or systemic scope Fine/day 2500‐3000 Fine/instance 2000‐

3000 **** **

See same list of actions (above) as actual or potential harm (serious resident impact) repeat/uncorrected widespread or systemic scope Fine/day 3000 Fine/instance 2000‐

3000 **** **

See same list of actions (above) Fine/day 2500‐3000Fine/instance 2500‐3000******

Isolated or Limited POC Fine/day

50‐1000 Fine/instan

ce ***

POC Fine/day 500‐

1000 Fine/instance

1000

POC Fine/day 1000‐

2000 Fine/instance

1000 condition of

license ****

POC Fine/day 1500‐2000 Fine/instance 1000‐1500 condition of license ****

See same list of actions (above) as actual harm (serious resident impact) initial citation widespread or systemic scope except no license suspension Fine/day 1500‐3000 Fine/instance 1500‐

3000 **** **

See same list of actions (above) as actual or potential harm (serious resident impact) repeat/uncorrected widespread or systemic scope

Fine/day 2000‐3000Fine/instance 2000‐3000****

POCstop placementFine/day 2000‐2500Fine/instance 2000‐3000department on‐site monitoring****

WhWwhaht

WhWwhaht

Contact Information:

Elena Madrid, RN BSN Carin A. Marney, Esq.Director of Regulatory Affairs Lane PowellWashington Health Care Association 206‐223‐7273T: 800‐562‐6170, ext. 105 [email protected]: 360‐352‐3304, ext. [email protected]

CarinA. Marney, Esq....In the case of actual or imminent threat to resident health or...

Documents

Transcript of CarinA. Marney, Esq....In the case of actual or imminent threat to resident health or...