Administrative Penalties Regulations Effective April 1, 2014

Objectives Understand the process used to determine if a deficiency rises to the level of an administrative penalty. Understand the financial impact of the administrative penalties when an I J does not exist. Calculate an administrative penalty using the penalty calculator tool.

Background: New Regulations Title 22 Division 5 Chapter 1 (General Acute Care Hospitals) Article 10: Hospital Administrative Penalties Effective April 1, 2014

Definitions Actual Financial Harm Deficiency Minor Violation Repeat Deficiencies Substantial Compliance Willful Violation Penalty Calculation

Nature of Deficiency Patient’s physical and mental condition. Probability and severity of the risk that the violation presents to patient. .

Severity of Deficiency Level-No actual patient harm but with potential for no more than minimal harm. Level 2-No actual patient harm but with potential for more than minimal patient harm, but not immediate jeopardy. Level 3-Actual patient harm that is not immediate jeopardy.

Severity of Deficiency Level 4-Immediate jeopardy to patient health or safety that is likely to cause serious injury or death. Level 5-Immediate jeopardy to patient health or safety that caused serious injury to a patient. Level 6-Immediate jeopardy to patient health or safety that caused the death of a patient. .

Scope of the Noncompliance Isolated One or a very limited number of patients affected; One or a very limited number of staff involved; or The situation occurred only occasionally; or The situation occurred in a very limited number of locations

Scope of the Noncompliance Pattern More than a very limited number of patients affected More than a very limited number of staff involved Situation occurred in several locations Same patient(s) had been affected by repeat occurrences .

Scope of Noncompliance Widespread: Situation was pervasive throughout the hospital Situation represented a systemic failure that affected or had the potential to affect a large portion or all of the hospital’s patients.

First Immediate Jeopardy Date of violation is > 3 years from last issued IJ penalty No additional IJ penalties Substantial compliance over 3 years prior to date of violation

Example 1 Event date: 4/10/14 Last I J deficiency was in January 2009 Substantial Compliance Past 4 years Is this a first Immediate Jeopardy event?

Example 2 Event Date - 4/10/14 Last IJ with AP levied 2/15/2012 Four deficiencies with harm in past 2 years Is this a first immediate jeopardy event?

3rd & Subsequent Deficiency Maximum Penalties Without Immediate Jeopardy $ 25,000 With Immediate Jeopardy 1st Deficiency $ 75,000 2nd Deficiency $100,000 3rd & Subsequent Deficiency $125,000

Adjustment: 10% Increase Severity Level 3 or 5 Actual Harm & Physical/Mental Impairment One or more major life activities Loss of bodily function Lasts more than seven days or present at discharge Loss of body part

Adjustment: 5% Increase Severity Level 3 or 5 Actual Harm & Physical/Mental Impairment One or more major life activities Loss of bodily function Lasts more than three days Loss of body part

Adjustments: 1% Increase Actual financial harm

Adjustment: 5% Decrease Factors beyond hospitals control to comply Example environmental disaster and P&P was followed

Adjustment: 10% Increase Deficiency Was Willful

Time to Practice Exercise 1 Exercise 2