1. Administrative Penalties
Regulations Effective
April 1, 2014

2. 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.

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

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

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

6. 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.

7. 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. .

8. 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

9. 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 .

10. 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.

11. 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

12. 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?

13. 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?

14. 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

15. 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

16. 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

17. Adjustments: 1% Increase
Actual financial harm

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

19. Adjustment: 10% Increase
Deficiency Was Willful

20. Time to Practice
Exercise 1
Exercise 2