Iowa Nursing Home Lobbyists Praise Lowered Fines Under Trump

Nursing home lobbyists in Iowa thanked federal regulators for lowering fines on facilities and asked them to “pursue a more collaborative — and less punitive — role” in nursing home regulation, the Des Moines Register reported Wednesday.

In a July 7 phone call arranged by U.S. Sen. Charles Grassley, R-Iowa, Iowa Health Care Association (HCA) President Brent Willett said “2016 cannot happen again,” in reference to record federal fines of $4.6 million paid by Iowa nursing homes in that year under the Obama administration.

A spokesperson for Grassley told the Register that the senator facilitated the call for Iowa HCA lobbyists “to help stakeholders connect to CMS directly” as he has done for other constituents.


The Centers for Medicare & Medicaid Services (CMS) delayed penalties for several new Requirements for Participation in November 2017, a decision that drew ire from a group of 17 state attorneys general earlier this year. Tom Miller, Iowa’s attorney general, was one of those.

Provider groups stressed at the time that CMS had not rolled back any regulations and that federal oversight of nursing homes had not been reduced.

Willett and colleagues “thanked” CMS for revising the assessment tool used to calculate fines against care facilities, according to a memo from the Iowa HCA cited by the Register.


A CMS manager noted that Iowa is still an “outlier” both regionally and nationally for the violations being cited, though the state is “trending downward overall” in terms of fines, the memo also indicated.

CMS made regular use of daily fines that had no cap on the total amount that could be imposed under the Obama administration; under Trump’s administration, the agency more frequently issues “per-instance” fines that are one-time and capped at $20,965, the Register said.

The results for Iowa were dramatic. CMS levied 10 times as many daily fines as the per-instance penalties in 2016, while in 2017, per-instance penalties represented 68% of all federal fines imposed, the Register reported. Between 2012 and 2016, federal fines imposed on Iowa nursing homes grew from $113,305 to $4.6 million annually, while individual fines grew from 26 in 2012 to 120 in 2016. Iowa nursing homes were also among the worst in the U.S. by 2016 for serious, repeat-offense violations that immediately jeopardized residents or caused them actual harm.

Federal fines against Iowa homes fell to $2.3 million in 2017, and though the number of violations that triggered fines rose slightly, the penalties on average were half what there were in 2016, according to a review by the Register.

Written by Maggie Flynn

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