Trump administration relaxes financial penalties against nursing homes

The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury. The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the […]

Trump administration relaxes financial penalties against nursing homes

The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.

The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.

“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.

Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.

The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.

The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up


Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.

“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.

But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.

“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.

Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.

The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress increased the fines to factor in several years of inflation that had not been accounted for previously.

The new rules have been instituted gradually throughout the year.

In October, CMS discouraged its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.

A July memo from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.

Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.

“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.

But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.

In September 2016, for instance, health inspectors faulted Lincoln Manor, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.

CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.

The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.

Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.

Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”

In November, the Trump administration exempted nursing homes that violate eight new safety rules from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.

Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”

In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.

“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in a speech in October. That paperwork is “taking doctors away from what matters most: patients.”

Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.

“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

We're ad free

That means that we rely on support from readers like you. Help us keep reporting on the most important New Mexico Stories by donating today.

Related

Lujan Grisham pocket vetoes two bills

Lujan Grisham pocket vetoes two bills

Gov. Michelle Lujan Grisham pocket vetoed two bills the legislature passed this legislative session: one changing the Cybersecurity Act and the other concerning law…
Gov signs bills with some vetoes 

Gov signs bills with some vetoes 

Gov. Michelle Lujan Grisham signed 69 bills that the legislature passed during the 2024 legislative session. These included the General Appropriations Act which contains…
Guv signs state budget

Guv signs state budget

Gov. Michelle Lujan Grisham signed the budget bill for Fiscal Year 2025 and the Capital Outlay spending bill. The FY25 state budget bill passed…
Advocates travel to D.C. to push for additional protections for the Gila River

Advocates travel to D.C. to push for additional protections for the Gila River

New Mexico advocates seeking to have the Gila River designated as a Wild and Scenic River will travel to Washington D.C. this week to…

NM Supreme Court annuls $10,000 penalty in PNM/Avangrid merger case

The New Mexico Supreme Court ruled on Monday that a penalty the New Mexico Public Regulation Commission levied against the state’s largest utility was…
State fines oil company more than $2 million after spill

State fines oil company more than $2 million after spill

The Energy, Minerals and Natural Resources Department fined an oil and gas company operating in the Permian Basin more than $2 million over produced…
Amid new graduation requirements, what do high schoolers want to learn?

Amid new graduation requirements, what do high schoolers want to learn?

By Margaret O’Hara, The Santa Fe New Mexican The main things that bring Brayan Chavez to school every day: Seeing, talking to and engaging with…
Special ed teachers hope lawmakers OK pay raises, admin changes

Special ed teachers hope lawmakers OK pay raises, admin changes

By Margaret O’Hara, The Santa Fe New Mexican Brittany Behenna Griffith has a laundry list of adjectives to describe the ideal special education teacher:…
Lawmakers must find consensus on competing education spending plans

Lawmakers must find consensus on competing education spending plans

By Margaret O’Hara, The Santa Fe New Mexican A challenging task awaits New Mexico lawmakers in the next 30 days: Reconciling three very different…
Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Lujan Grisham, Biden admin announce $10 million in federal funds for tribes, pueblos

Gov. Michelle Lujan Grisham announced Friday $10 million in funding from the federal American Rescue Plan Act was awarded to six tribal nations and…
Proposal to curb executive powers moves to House Judiciary

Proposal to curb executive powers moves to House Judiciary

The House Government, Elections and Indian Affairs Committee discussed a potential constitutional amendment that seeks to limit the governor’s executive powers. The committee approved…
Supreme Court censures attorney over conduct in anti-COVID policy suits

Supreme Court censures attorney over conduct in anti-COVID policy suits

The New Mexico State Supreme Court censured a New Mexico attorney because of her “misconduct” in two unsuccessful cases pushing back on COVID-19 regulations…
Supreme Court to hear two abortion cases this spring

Supreme Court to hear two abortion cases this spring

Later this month, the U.S. Supreme Court will hear oral arguments on the case against the abortion medication mifepristone. It will hear a second…
How Biden, others highlighted reproductive rights at the State of the Union

How Biden, others highlighted reproductive rights at the State of the Union

President Joe Biden highlighted reproductive rights issues as part of his State of the Union speech Thursday. Biden delivered his 2024 State of the…
Stansbury invites OB-GYN doctor as her state of the union guest 

Stansbury invites OB-GYN doctor as her state of the union guest 

U.S. House of Rep. Melanie Stansbury has invited an OB-GYN doctor from Roswell as her guest for President Joe Biden’s State of the Union…
Supreme Court to hear two abortion cases this spring

Supreme Court to hear two abortion cases this spring

Later this month, the U.S. Supreme Court will hear oral arguments on the case against the abortion medication mifepristone. It will hear a second…
How Biden, others highlighted reproductive rights at the State of the Union

How Biden, others highlighted reproductive rights at the State of the Union

President Joe Biden highlighted reproductive rights issues as part of his State of the Union speech Thursday. Biden delivered his 2024 State of the…
Stansbury invites OB-GYN doctor as her state of the union guest 

Stansbury invites OB-GYN doctor as her state of the union guest 

U.S. House of Rep. Melanie Stansbury has invited an OB-GYN doctor from Roswell as her guest for President Joe Biden’s State of the Union…
See who’s going to be on your primary ballot in June

See who’s going to be on your primary ballot in June

Tuesday marked the official beginning of the 2024 New Mexico primary season for the legislature, with candidates officially filing for candidacy. This is the…

Bill to require disclosure of use of AI in campaign materials goes to governor

The Senate approved a bill aiming to require the disclosure of the use of artificial intelligence or other changes made by computers to campaign…
House amends, passes bill banning firearms near polling places

House amends, passes bill banning firearms near polling places

The House narrowly approved a bill that would ban firearms near polling places. The House voted 35-34 to pass the bill following an extensive…
Advocates travel to D.C. to push for additional protections for the Gila River

Advocates travel to D.C. to push for additional protections for the Gila River

New Mexico advocates seeking to have the Gila River designated as a Wild and Scenic River will travel to Washington D.C. this week to…
U.S. Supreme Court lets ban on Couy Griffin from holding office stand

U.S. Supreme Court lets ban on Couy Griffin from holding office stand

The U.S. Supreme Court declined to hear an appeal of a Republican official who was barred from holding office after being convicted for a…
Politics Newsletter: legislative leaders not running for reelection

Politics Newsletter: legislative leaders not running for reelection

Hello fellow political junkies! Candidate filing day has come and gone, and members of House and Senate leadership opted to either not seek reelection…

GET INVOLVED

© 2023 New Mexico Political Report