Optional Denial of Payment

1. Optional Denial of Payment

2. Effective April 2, 2012: CMS Region VI delegated State Survey Agencies the authority to provide notice to SNF and SNF/NF facilities that CMS will impose Optional Denial of Payment for New Admissions (ODPNA) in a “No Opportunity to Correct Before Remedies are Imposed” Enforcement Action.

3. Opportunity to Correct Survey: Facility is allowed an opportunity to correct identified deficiencies before remedies are imposed. Includes Deficiencies written at Scope and Severity of A, B,C, D, E, F, G (not double G)

4. No Opportunity to Correct Survey The facility will have remedies imposed immediately after determination of noncompliance has been made.

5. No Opportunity to Correct Situations Include: 1. Immediate Jeopardy (IJ) not lifted prior to exit - two (2) day notice of ODPNA 2. Immediate Jeopardy (IJ) lifted prior to exit – 15 day notice of ODPNA 3. Double “G” – 15 day notice of ODPNA

6. Purpose of Delegating Notice of ODPNA: “To encourage the facility to achieve prompt compliance and to sustain compliance with the Medicare/Medicaid Requirements of Participation.”

7. Change in Process for Providers: Effective date for ODPNA is now from date of initial letter sent from Health Standards Section, not from CMS letter.

8. ODPNA Enforcement Letter Contains New / Revised Paragraphs: - Optional Denial of Payment for New Admissions (ODPNA) - Appeal Rights paragraph revised

9. Contact Information:Cindy Collins, RN, CCRNMedical Certification Program ManagerPhone: 225-342-1997E-Mail: cindy.collins@la.gov