HHSC CMP Project Application Guidance

The Centers for Medicare & Medicaid Services imposes civil money penalties against Medicare- or Medicaid-certified nursing facilities found out of compliance with the federal requirements for long-term care facilities.

Sections 1819 and 1919 of the Social Security Act allow CMP funds to be used for projects and activities that benefit residents, including those that:

  • Support and protect residents of a facility that closes or is decertified
  • Support resident and family councils and other consumer involvement to ensure quality care
  • Improve the facility through CMS-approved initiatives, such as culture change

States must obtain approval from CMS before using federally imposed CMP funds to pay for projects. Twice a year, HHSC evaluates proposals to use CMP funds by using criteria developed by CMS and published in CMS S&C 12-13-NH (PDF). A decision by HHSC not to forward a proposal to CMS is not subject to appeal.

To request CMP Reinvestment funds for a project, complete

Submit the completed application to the CMP Application mailbox.

If you have any questions, please contact Stacie Flenoy at CmpApplication@hhsc.state.tx.us or at 512-438-2652.

Tips for Completing an Application

  • Answer each question completely. If the question has multiple components, please address each component.
  • Provide specific details about what activities you plan to engage in; do not assume the reader will know what you plan to do.
  • Ensure that your summary is an actual summary and not a complete project description.
  • Include expected outcomes and how those outcomes will be measured.
  • Include an explanation of how the project will directly benefit the nursing facility residents.
  • If your project includes training, provide specific details as to how the facility or staff will incorporate training into daily practice and how that training will improve resident outcomes.
  • Include a realistic timeline for activities.
  • Include a line-item budget with the itemized costs of requested reimbursements in an Excel spreadsheet (i.e. cost of item, quantity being purchased, taxes, shipping, if applicable and the total cost). HHSC will not pay for items not listed in the itemized budget and the resultant CMP agreement.
  • If you plan to purchase products, please include specific product information with your application sufficient to describe the item and to demonstrate that the item is available at the cost stated.
  • Include a complete list of organizations. If you plan to use subcontractors, please identify those subcontractors.
  • Identify the signature authority (and their title) for the CMP agreement.

Frequently Asked Questions

What information is important to include in my application?

It is important to include a detailed budget sheet with explanations for each cost. If the proposal includes purchasing items such as machinery or furniture, include a specification sheet showing details of the item and bids. Cost estimates from vendors are very helpful.

You must also submit the HHSC Supplement to the Application for CMP Funds (PDF) with your application response.

What types of items will not be allowed in my cost estimate?

HHSC does not approve costs that involve renovation of infrastructure (e.g., rewiring electrical outlets, moving walls, resurfacing floors). The applicant needs to have a plan for paying for renovations, which may include donations, fund raising, etc.

It is important to include a detailed budget sheet (in an Excel spreadsheet) with explanations for each cost. If the proposal includes purchasing items such as machinery or furniture, include a specification sheet showing details of the item and bids. Cost estimates from vendors are very helpful.

Can CMP funds be used for the cost of travel and per diem for meals?

Yes. Any conferences, with or without travel, necessary to accomplish the purpose of the grant must have prior CMS approval. These requests must be priced separately in the budget and include the following information:

  1. A description of their purpose
  2. The number of participants attending
  3. A detailed statement of the cost to the project
  4. The cost of any food or beverages
  5. The cost of audio-visual services for a conference
  6. The cost of employee or contractor travel to and from a conference; and
  7. A discussion of the methodology used to determine which costs relate to a conference

If the cost estimate includes travel, HHSC will reimburse using State of Texas travel rates.

To apply for funding for several locations, should each location be submitted as a separate application?

No. If the project will be the same at each location, the organization should submit one application and attach a list of all the locations included in the budget plan. One application is also acceptable if the projects will vary only slightly in detail from location to location.

What if there is a significant variance for one or several locations?

If there is a significant variance in the project, the organization would need to submit separate applications for each location that has the significant variance.

If my CMP plan involves any construction, structural changes or electrical work to the facility, are there any additional actions that need to be completed?

Yes. If your project involves any type of construction (e.g., building a greenhouse, courtyard, awning, installing a kitchenette) you need to provide a plan and specifications to HHSC Life Safety Code staff for review before submitting your application. You must then provide their response with your application. Please also ensure that your application is specific and states how you will follow through with HHSC LSC staff if your proposal is approved by CMS.

If my organization has a project sponsor or any subcontractor that is not a health care provider already required to comply with HIPAA, and the project includes contact with nursing facility residents or their families, will any additional actions need to be taken?

Yes. You will be required to complete a Data Use Agreement (PDF) as prescribed by the Texas Health and Human Services Commission.

What Happens After I Submit My Application?

Each application received during the submission period is reviewed for completeness. Applicants with incomplete applications are given the opportunity to complete by a specific deadline. An application must be complete to be considered. Each application submitted will receive a "receipt by" date and all complete applications will receive a "complete" date. Projects are funded based on the receipt date and are subject to available funding, HHSC review and CMS approvals.

Depending upon the complexity of your proposal or the quality of your application, HHSC may request additional information. After the close of the application period, the HHSC-designated CMP panel will determine whether to forward your proposal to the HHSC commissioner for approval. The CMP panel evaluates proposals by applying the CMS criteria set forth in S&C 12-13-NH and 42 CFR 488.433. Applications approved by the HHSC commissioner will be forwarded to CMS for approval.

If your proposal is forwarded to CMS, CMS may request additional information. If CMS approves your proposal, HHSC will develop a CMP agreement that describes the terms, conditions, deliverables and time frames required for disbursement of CMP funds. Please be aware that HHSC does not disburse CMP funds before invoices and receipts are received.

When Can an Entity or Facility Begin Purchasing for Their CMP Project?

An entity or facility should not incur any cost obligations for the CMP project until the HHSC commissioner or designee has signed the CMP agreement. Reimbursement will not be made until the CMP agreement has been fully executed.

Disclaimer: This guidance is not legal advice from HHSC, and applicants should consult their legal counsel as they deem appropriate.

How often may applications for CMP funds be submitted?

Applications for CMP funds are received twice a year. The application periods are:

  • Jan. 1 – Feb. 28
  • July 1 – Aug. 31

Is there a grace period for submitting applications after the deadline?

No. All applications must be submitted via email before 11:59 p.m. of the deadline date. There are no exceptions.

Who may apply for CMP funds?

HHSC may distribute funds to any entity provided that the funds are used for CMS-approved projects to protect or improve services for residents of Medicare- or Medicaid-certified nursing facilities and provided that the responsible receiving entity is:

  • Qualified and capable of carrying out the intended project or use
  • Not in a conflict-of-interest relationship with the entity or entities that will benefit from the intended project or use
  • Not a recipient of a contract, grant or other payment from federal or state sources for the same project or use
  • Not paid by a state or federal source to perform the same function as the CMP project or use
  • A qualified nursing facility that has no Immediate Jeopardy, Substandard Quality of Care or Immediate Threat finding in the 6 months immediately prior to the beginning of the application period.

CMP funds may not be used to enlarge or enhance an existing appropriation or statutory purpose that is substantially the same as the intended project or use.

Can a facility apply for CMP funds if it has a pending CMP?

A facility that has pending CMPs may apply for CMP funds. The facility's application may be suspended until HHSC receives the final disposition of the pending CMP.

If an organization or corporation is applying for funding for several facilities and one or more facilities has a pending CMP, will the application for the organization be suspended?

No. The application for the organization will not be suspended. If the application is approved by the HHSC commissioner or designee and CMS, the applicant will be provided a letter stating that the funds may be used for all facilities except the facility with the pending CMP until HHSC receives the final disposition of the CMP.

What projects may be funded with CMPs?

HHSC encourages CMP funds be used for projects that directly benefit residents of Medicare- or Medicaid-certified nursing facilities, including activities to implement CMS initiatives such as the National Partnership to Improve Dementia Care in Nursing Homes. CMS has approved the use of CMP funds to finance projects such as:

  • Culture change projects
  • Resident or family councils
  • Direct improvements to quality of care
  • Consumer information
  • Resident transition due to facility closure or downsizing
  • Preparing residents for community placement
  • Training for facility staff and surveyors

What projects may not be funded with CMP funds?

CMP funds may not be used to pay for:

  • Projects for which a conflict of interest (or the appearance of a conflict) exists
  • Functions for which an entity is already receiving funds from state or federal sources
  • Capital improvements to a nursing home or to build a nursing home
  • Nursing home services or supplies that are the responsibility of nursing homes, such as laundry, linen, food, heat, staffing costs, etc.
  • Recruitment or certification training for Long Term Care Ombudsman staff or volunteers or to investigate and resolve complaints
  • Activities that have already occurred
  • Research Studies
  • Activities that benefit individuals who are not residents of a Medicare or Medicaid certified facility

Are CMP funds provided in advance of project completion?

No. HHSC does not disburse CMP funds before project completion. Organizations will need to submit invoices and receipts for completed projects in order to be reimbursed for expenses incurred pertaining to the project. Reimbursement will be made approximately 30 days after processing the invoice.

Approved Projects for Civil Money Penalties

Approved Projects

Entity Awarded CMP Funds Purpose of Project Amount Awarded Status

Southwest LTC Management Services

Education-Centered Approach to Culture Change and Enhancement of Quality Measures-in house training center for 24 facilities

$304,383.38

Project Ongoing

HHSC Quality Monitoring Program

Texas Nursing Facility Director of Nursing Training Academy with multiple training seminars to be held across the state

$121,080.00

Complete

HHSC Quality Monitoring Program

Texas Reducing Antipsychotics in Nursing Homes Phase II, Providing Individualized Assistance and Support

$421,948.00

Project Ongoing

HHSC Quality Monitoring Program

Music and Memory Initiative

$872,540.00

Project Ongoing

Texas Healthcare Association

Dementia training and coaching

$416,506.36

Project Ongoing

Sava Senior Care Administrative Services, LLC

Texas Facilities Dementia Care Improvement Initiative

$249,530.00

Project Ongoing

Texas Healthcare Association

Online clinical resource center

$543,171.20

Project Ongoing

HHSC Aging Services Coordination Unit

PS V position to oversee 3 years of support of volunteers and volunteer programs in Texas nursing facilities

$237,068.00

Project Ongoing

State Long-term Care Ombudsman’s Office

Funding for two-year self-advocacy and community organizing pilot project for residents

$211,056.46

Project Ongoing

Cleveland Health Care Center

Virtual Dementia Tour trainings

$6,573.09

Project Ongoing

HHSC Quality Monitoring Program

Certified Nurse Aide Training Academy

$303,960.00

Project Ongoing

HHSC Quality Monitoring Program

Advanced Person-Centered Behavior Training for Residents with Dementia

$292,160.00

Project Ongoing

HHSC Quality Monitoring Program

Life Enrichment in a Person-Directed Environment Training

$281,260.00

Project Ongoing

State Long-Term Care Ombudsman

Resident Council Toolkit

$10,803.03

Project Ongoing

TMF Health Quality Institute

Smile Proud: Improving Oral Health toolkit

$667,141.00

Project Ongoing

TMF Health Quality Institute

Improving knowledge in early identification toolkit

$362,219.00

Project Ongoing

The Renaissance at Kessler Park

IN2L computer technology

$30,820.94

Project Ongoing

Oaks Nursing Center

Virtual Dementia Tour Training

$6,250.00

Project Ongoing

West Central Texas Council of Governments

Implementation of self-advocacy program

$172,414.00

Project Ongoing

State Long-term Care Ombudsman’s Office

Production of 6 person-centered care training videos

$25,475.33

Project Ongoing

HHSC Quality Monitoring Program

Intellectual and developmental disabilities and mental illness training academy

$223,597.60

Project Ongoing

HHSC Quality Monitoring Program

Hand feeding technique training

$336,962.24

Project Ongoing

HHSC Quality Monitoring Program

Music & Memory Initiative Phase 4

$550,651.60

Project Ongoing

Winfield Rehab & Nursing

IN2L computer technology

$17,660.99

Project Ongoing

Winfield Rehab & Nursing

IN2L computer technology

$12,099.00

Project Ongoing

McAllen Nursing Center and Rehab

IN2L computer technology

$25,947.59

Project Ongoing

Advanced Healthcare Solutions

IN2L computer technology

$64,603.60

Project Ongoing

Community Care Center of Crockett

IN2L computer technology

$12,099.00

Project Ongoing

MRC The Crossing

IN2L computer technology

$44,717.00

Project Ongoing

Silsbee Oaks Healthcare

Installation of a Gazebo

$11,012.70

Complete

Civil Money Penalty Funds for NF Projects

Next CMP Application Period

NOTE: The next application submission period is approaching fast. Applications may be submitted July 1, 2018, through Aug. 31, 2018. 

The Texas Department of Aging and Disability Services has been consolidated into the Texas Health and Human Services Commission, effective Sept. 1, 2017. All correspondence regarding Civil Money Penalty funds will now be from HHSC Regulatory Services staff.