DADS CMP Project Application Guidance

The Centers for Medicare & Medicaid Services (CMS) imposes civil money penalties (CMPs) 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, the Texas Department of Aging and Disability Services (DADS) 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 DADS not to forward a proposal to CMS is not subject to appeal.

To request CMP funds for a project, complete the Application for CMP Funds (MS Word format), including the Response to DADS Supplement to the Application for Civil Monetary Penalty Funds (PDF) and Form 4732 Nongovernmental Contractor Certification (PDF). Submit the completed application to the CMP Application mailbox.

If you have any questions, please contact Stacie Flenoy at CmpApplication@dads.state.tx.us or at 512-438-4425.

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 explanation of how the project will directly benefit the nursing facility residents
  • If your project includes training, provide specific details as to how a 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 in which all cost that reimbursement will be requested for are itemized (i.e. cost of item, quantity being purchased, taxes, shipping, if applicable and the total cost). DADS will not pay for any 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

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 with your application response, The Department of Aging and Disability Services Supplemental to the Application for Civil Monetary Penalty Funds (PDF).

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

DADS does not approve costs that involve renovations to infrastructure (i.e., rewiring electrical outlets, moving walls, resurfacing floors). The applicant will want to have a plan for how to pay for renovations, which may include donations, fund raising, etc.

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

Yes. Any conferences, with or without travel, that you believe are 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 its 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 DADS, will reimburse in accordance with the current State of Texas travel rates.

If an organization wishes to apply for funding for several locations, should each location be submitted as a separate application?

No. If the project for several locations will be exactly the same, then the organization should submit one application and attach a list of all the locations that are to be included in the budget plan. This approach is also acceptable if the projects will vary only slightly in detail from location to location.

What happens if there is a significant variance for one or several locations? What would the organization need to do?

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 project/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 (i.e. building a green house, courtyard, awning, installing a kitchenette) you will need to provide a plan and specifications to DADS Life Safety Code (LSC) staff for review prior to 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 DADS 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 as prescribed by the Texas Health and Human Services Commission. The Data Use Agreement can be located at https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/contracting/data-use-agreement.pdf.

What Happens After I Submit My Application?

Each application reviewed during the submission period is reviewed for completeness. Applicants with incomplete applications are contacted and 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, subject to available funding, DADS and CMS approvals. Depending upon the complexity of your proposal or the quality of your application, DADS may request additional information. After the close of the application period, DADS designated CMP Panel members will make a determination whether to forward your proposal to the DADS 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 DADS 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, DADS will develop a CMP Agreement that describes the terms, conditions, deliverables and time frames required for disbursement of CMP funds. Please be aware that DADS does not disburse CMP funds prior to the receipt of invoices and receipts.

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

An entity or facility should not incur any cost obligations for the CMP project until the DADS Commissioner or designee has signed the CMP Agreement. Reimbursement will not occur until the CMP Agreement has been fully executed.

Disclaimer: This guidance shall not be considered legal advice from DADS and applicants should consult their legal counsel, as they deem appropriate.

Frequently Asked Questions

How often may applications for CMP funds be submitted?

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

  • Jan. 1 through Feb. 28
  • July 1 through 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?

DADS 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 any 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 (IJ), Substandard Quality of Care (SQC) or Immediate Threat (IT) finding in the 6 months 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 DADS receives the final disposition of the pending CMP.

If an organization/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 DADS Commissioner 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 DADS receives the final disposition of the CMP.

What projects may be funded with CMPs?

DADS 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. DADS does not disburse CMP funds in advance of 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
Congregation of Divine Providence/ McCullough Hall Implementation of Culture Change and Quality of Care at McCullough Hall Nursing Center $73,000 Project Ongoing
Impera Consulting Training on prevention and control of C-diff and multi-drug resistant organisms (MDROs) in nursing homes with multiple training seminars to be held across the state $320,000 Project Ongoing
DADS Centers for Policy and Innovation, Quality Monitoring Program Texas Nursing Facility Director of Nursing Training Academy with multiple training seminars to be held across the state $121,080 Project Ongoing
DADS Centers for Policy and Innovation, Quality Monitoring Program TRAIN (Texas Reducing Antipsychotics in Nursing Homes)Phase II, Providing Individualized Assistance and Support $421,948 Project Ongoing
Eden Alternative Leveraging leadership to drive sustainable change $909,199 Project Ongoing
DADS Centers for Policy and Innovation, Quality Monitoring Program Music and Memory Initiative $872,540 Project Ongoing
Regency Healthcare and Rehabilitation Center Purchase of 1.) soft serve ice cream machine and 2.) self-service laundry room $9001.99 Complete
Brookhaven Nursing and Rehabilitation Center Shadowbox/Memory Box $4,500 Project Ongoing
Texas Healthcare Association (THCA) Dementia Training and Coaching $416,506.36 Project Ongoing
White Settlement Nursing Center It's Never 2 Late (IN2L) computer technology $12,099 Project Ongoing
Medina Valley Health and Rehabilitation Center It's Never 2 Late (IN2L) computer technology $27,742 Project Ongoing
Sherman Healthcare Center Snoezelen Room $10,000 Project Ongoing
Cibolo Creek Health and Rehabilitation Center It's Never 2 Late (IN2L) computer technology $27,742 Project Ongoing
Sava Senior Care Administrative Services, LLC Texas Facilities Dementia Care Improvement Initiative $249,530.00 Project Ongoing
Alamo and Bexar Ombudsman AAA Aging sensitivity training program $3,373.22 Project Ongoing
West TX LTC Partners dba Cedar Manor Music and Memory initiative $3,961.50 Project Ongoing
Texas Healthcare Association (THCA) Online clinical resource center $543,171.20 Project Ongoing
Bremond Nursing & Rehabilitation Dining at home: Purchase of dining room items to enhance the dining experience for residents. $5,000.00 Project Ongoing
Woodlake Nursing Home Purchase of blanket/towel warmer $6,798.95 Project Ongoing
HHSC Aging Services Coordination Unit (ASC) PS V position to oversee 3 years of support of volunteers and volunteer programs in Texas at-risk nursing facilities $237,068.00 Project Ongoing
Trucare Living Centers – Columbus Installation of an enclosed courtyard $19,570.00 Project Ongoing
DADS 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
The Courtyards at Pasadena Installation of greenhouse and concrete wheelchair accessible paths $14,456.00 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
Advanced Rehab & Healthcare of Vernon IN2L computer technology $13,815.96 Project Ongoing
DADS State Long-Term Care Ombudsman Resident Council Toolkit $10,803.03 Project Ongoing
Azle Manor Health Care, LLLP Purchase of a soft serve ice cream machine $12,165.51 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
Cartmell Home for Aged, Inc Purchase of 2 soft serve ice cream machines $8,481.73 Project Ongoing

Summer 2017 Application Period Cancelled

Because DADS will be merging with the Texas Health and Human Services Commission on Sept. 1, 2017, the summer 2017 Civil Money Penalties (CMP) application period has been cancelled. The next CMP application period is expected to be Jan. 1-Feb. 28, 2018.

Providers will be notified when applications will be accepted.