Today, the Centers for Medicare & Medicaid Services' (CMS) final rule on the Prospective Payment System for Fiscal Year 2025 was published in the Federal Register.¹ Despite its name, skilled nursing facilities need to be aware that this final rule includes, among many other things, significant changes to CMS’s ability to impose Civil Money Penalties (CMP) on skilled nursing facilities as a result of survey findings.

As a result of this final rule, CMS has given itself the power to:

• Impose multiple per-instance penalties based on findings of noncompliance from a single survey;
• Impose both a per-day and per instance penalty based on findings of noncompliance from a single survey;
• Impose penalties on previously cited noncompliance for a longer look-back period of the last three standard surveys.

CMS is no longer limiting itself to imposing remedies based on specific F-tags or imposing a single type of monetary remedy per survey. Instead, in an era where regulatory interpretation and CMP are under close scrutiny as the subject of Supreme Court decisions, CMS has ratcheted up its ability to impose CMPs on skilled nursing facilities based on its updated interpretation of the Social Security Act.

This rule will become effective on October 1, 2024, but the requirements regarding CMPs are set to be operationalized beginning March 3, 2025.

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¹ (Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities, 89 Fed. Reg. 64048 (Aug. 6, 2024).