Medicare and Medicaid programs; intermediate sanction for long-term care facilities--HCFA. Final rule

These final regulations provide an alternative to terminating Medicare and Medicaid provider agreements with long-term care facilities that are found to be out of compliance with conditions of participation or standards. In facilities with deficiencies that do not pose immediate jeopardy to the health and safety of patients, HCFA and State Medicaid agencies will have the option of either terminating the provider agreement or denying payment for new admissions. In facilities with deficiencies that do pose immediate jeopardy to the health and safety of patients, HCFA and State Medicaid agencies must terminate the provider agreements. In such cases, under the terms of the statute, HCFA will, and the Medicaid agency may, additionally seek to impose the denial of payment sanction. These regulations are necessary to implement section 916(a) of the Omnibus Reconciliation Act of 1980. The denial of payment sanction is intended to promote correction of deficiencies without having to exclude facilities from the program.