Civil Money Penalty (CMP) Funds
The purpose of the CMP Program is to reduce deficient practices resulting in improved quality of care and quality of life for individuals residing at nursing homes or receiving home health services.
A CMP is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against certified nursing homes for either the number of days, or for each instance, a nursing home is not in substantial compliance with one or more Medicare and Medicaid participation requirements for long-term care facilities. A portion of CMPs collected from nursing homes are returned to the states in which CMPs are imposed. State CMP funds may be reinvested to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life.
In accordance with the Use of Federally Imposed Civil Money Penalty (CMP) Funds by States memorandum issued by CMS on December 16, 2011, States must obtain approval from CMS for the use of federally imposed civil money penalty funds. Effective January 1, 2012, CMS has established a process for reviewing applications that seek funding to improve resident outcomes in certified nursing homes. Only CMP fund applications that meet the statutory intent of the Federal regulations, law, and policy will be reviewed.
Goals of the CMP Program
The goals of the CMP Program are to:
- Promote evidence-based care;
- Encourage conversations on quality of care and quality of life;
- Address issues identified through quality and needs assessments as part of a quality assessment and performance improvement process;
- Provide education and training programs specific to the nursing home resident populations;
- Provide assistance to ensure the health and safety of New Hampshire nursing home residents during relocations; and
- Support state infrastructure towards development of innovative programs directed towards improving quality of care and quality of life for nursing home residents.
Who may apply for the use of CMP funds?
Funds may be granted to any entity for proper use of CMS-approved projects to protect or improve the quality of life for nursing facility residents provided that the responsible receiving entity is:
- Qualified and capable of carrying out the intended project or use;
- Not in any conflict of interest relationship with the entity or entities that will benefit from the intended project or use; and
- Not paid by a State or federal source to perform the same function as the CMP project or use. CMP funds may not be used to enlarge or enhance an existing appropriation or statutory purpose.
Examples of eligible organizations include, but are not limited to:
- Consumer advocacy organizations;
- Resident or family councils;
- Professional or State nursing home associations;
- Certified long-term care facilities (SNF, NF, SNF/NF); and
- Private contractors.
Why are CMP funds available and how can they be used?
Sections 1819(h)(2)(B)(ii)(IV)(ff) and 1919(h)(3)(C)(ii)(IV)(ff) of the Social Security Act (the Act) incorporate specific provisions of the Patient Protection and Affordable Care Act, (the Affordable Care Act) (Pub. L. 111-148) pertaining to the collection and uses of CMPs.
The Act and regulation provides that CMP funds may be used to support activities that protect or improve the quality of care or quality of life for residents. This may include any of the following:
- Assistance to support and protect residents of a facility that closes or is decertified;
- Time-limited expenses incurred in the process of relocating residents to home and community-based settings or another facility when a facility is closed or downsized pursuant to an agreement with the State Medicaid Agency;
- Projects that support resident and family councils and other consumer involvement in assuring quality care in facilities;
- Facility improvement initiatives such as joint training of facility staff and surveyors or technical assistance for facilities implementing quality assurance and performance improvement programs;
- Development and maintenance of temporary management or receivership capability. A temporary manager’s salary must be paid by the facility unless CMS stops or suspends payments to the facility under 42 CFR Part 489.55 during the temporary manager’s duty period, and CMS determines that extraordinary action is necessary to protect the residents until relocation efforts are successful; and
Expenses incurred by a State related to CMP uses (i.e., administrative expenses related to administering, monitoring, and evaluating CMP projects).
What are some examples of non-allowable uses of CMP reinvestment funds?
An applicant requested funding for three years to develop and test educational models for training and a patient engagement assessment tool, however only six months of the project focused solely on the delivery of the training. This application is not appropriate for the use of CMP funds, because a large portion of the budget was for research (i.e., development and testing) to determine whether a tool was beneficial to residents rather than implementation of a program that directly benefits the lives of nursing homes residents.
Indirect Benefit to Nursing Home Residents
An application from a healthcare association requested funding to provide training to multiple nursing homes in the state, however the application did not contain letters of commitment or other documentation of demand for such a training from nursing homes. Therefore, while the requestor anticipates a certain level of participation, they would receive funds even if only a few facilities participate in the training. The budget also included costs for breakfast and lunch as part of the training event. This application is incomplete, because there is no evidence the applicant has nursing home buy-in to participate in the training, which could ultimately result in no direct benefit to residents. The application also proposed to use funds for refreshments, which is an inappropriate use of CMP funds.
An applicant requested funding for a new sound (e.g., intercom) system for the nursing home to replace the current system due to poor sound quality. This application is inappropriate, because it contains costs for permanently affixed audio components that are designed to upgrade the nursing home’s audio system.
Duplication of CMS Requirements
Nursing homes must meet emergency preparedness requirements of participation. Therefore, an application to assist a nursing home prepare for an emergency containing a funding request for satellite phones or other communication back-up systems, evacuation transportation, rentals of portable generators or air conditioning, and emergency water, food and medicine supplies is not appropriate for CMP funding.
Charging for Nursing Home Employee Salary
An application to implement a training program to improve staff engagement contained a request for funds to pay the salary of the training coordinator, who was an existing employee of the nursing home applicant. This application is inappropriate, because CMP funds cannot be used to pay for the salary of a nursing home employee.
New Hampshire Application Process
- CMP requests shall be submitted to the State Agency Director (SAD), or their designee. All CMP requests shall be submitted electronically utilizing the CMP Grant Request Form.
- All requests shall be submitted to CMP@dhhs.nh.gov. Requests will not be accepted any other way unless pre-approved by the SAD.
- The font for all CMP request forms is Times New Roman, size twelve (12) point, and shall include the entity name and page numbers on all documents.
- Requests should be limited to no more than twenty (20) pages, including appendices and the CMP request form.
- All sections of the CMP request form shall be completed or the request for funds may be denied.
- When CMP funds are requested, the organization involved must also include the following:
- Anticipated number of attendees;
- Target audience;
- Accrediting authorities; and
- Timeline for implementation and plan for sustainability.
- Representatives from any group requesting funding, or representatives who are in situations where a conflict of interest exists must disqualify themselves from providing letters of support.
- Applicants may contact the SAD with questions regarding their CMP request. Following state agency review, the CMP request form shall be forwarded to the CMS electronic mailbox for a decision.