LeadingAge submitted comments on the Fiscal Year (FY) 2025 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) proposed rule on May 23. Access these comments here.

As explained in this press statement, “LeadingAge to CMS: to Achieve Improvements, Focus on Nursing Homes’ Needs,” the proposed rule includes a provision that would expand the authority of the Centers for Medicare & Medicaid Services (CMS) to enforce civil money penalties (CMPs) against nursing homes for noncompliance with Requirements of Participation.

The potential additional financial strain to providers should CMS expand its authority to enforce CMPs—without revising the survey process to allow for constructive feedback and educational support for providers—is troubling, LeadingAge says in its comments.  The proposal, which would allow for both per instance and per day CMPs to be enforced for noncompliance in the same survey and also to allow for multiple CMPs to be enforced in the same survey for the same noncompliance, threatens to force providers to make difficult choices. If, for instance, their CMPs increase, what trade offs must be made? Should spending on worker recruitment and retention or training staff on critical resident needs in areas such as behavioral health be reduced?

Many of our nonprofit, mission-driven nursing home provider members are asking the obvious: will the monies derived from the potential increase in monetary penalties be used to fund CMS’ $75 million staffing campaign—one created, the agency says, to assist nursing homes in meeting minimum staffing standards?

LeadingAge recommends a different approach. Rather than penalizing nursing homes through increased fines, CMS would do better by turning its attention to survey process reform—in particular, allowing for constructive feedback and educational support. A punitive approach focusing on fines alone will not improve quality of care in nursing homes.

For more background on the proposed rule, see our serial post, Nursing Home Payment Rule FY2025.