Denial of Payment for New Admissions (DPNA) is often confused with the state of Washington’s enforcement remedy, Stop Placement. It is important to understand the difference between state remedies and the Federal enforcement actions. While a state Stop Placement can pertain to all residents regardless of payer type, a federal DPNA generally applies to Medicare/Medicaid.
This remedy may, and in certain instances, must, be imposed by CMS or the State Agency (SA). DPNA may be imposed alone or in combination with other remedies to encourage quick compliance. Formal notice of the imposition and rescission of this remedy may also be provided by the state.
This remedy may be imposed anytime a facility is found to be out of substantial compliance if the facility is given written notice at least two calendar days before the effective date in immediate jeopardy situations and at least 15 calendar days before the effective date in non-immediate jeopardy situations.
CMS will accomplish the denial of payment remedy through instructions to the appropriate Medicare Area Contractor. Regardless of any other remedies that may be imposed, DPNA must be imposed when the facility is not in substantial compliance three months after the last day of the survey identifying deficiencies, or when a facility has been found to have furnished substandard quality of care on the last three consecutive standard surveys.
Generally, if the facility achieves substantial compliance and it is verified, CMS or the SA must resume payments to the facility prospectively from the date it determines that substantial compliance was achieved. However, when payment is denied for repeated instances of substandard quality of care, the remedy may not be lifted until the facility is in substantial compliance and the state or CMS believes that the facility will remain in substantial compliance. No payments are made to reimburse the facility for the period between the date the remedy was imposed and the date that substantial compliance was achieved.
CMS may impose the DPNA remedy whenever a facility has not met a requirement; it is a severe sanction. Factors to be considered in selecting this remedy could include:
- Seriousness of current survey findings.
- Noncompliance history of facility; and
- Use of other remedies that have failed to achieve or sustain compliance.
If you have questions regarding state or federal enforcement remedies for skilled nursing facilities, please email Elena Madrid or call her at (800) 562-6170, extension 105.