What is a DPNA in a nursing home?

A DPNA (Denial of Payment for New Admissions) is a Medicare enforcement sanction under 42 CFR §488.417 where CMS bars a nursing home from billing Medicare for any resident admitted during the ban period. Current residents are unaffected. The DPNA ends when CMS resurveys the facility and confirms it has returned to compliance.

How does CMS decide to impose a DPNA?

CMS imposes a DPNA when a survey finds that a nursing home has immediate jeopardy deficiencies (severity G or higher) or sustained noncompliance across multiple surveys. The penalty is designed to pressure facilities into rapid correction — financial loss from the ban creates urgency to resolve deficiencies quickly.

How long does a nursing home Medicare payment ban typically last?

The average DPNA in the CMS three-year window lasted 28 days; the median was 19 days. Most bans are short because the goal is rapid return to compliance. A long tail exists — the longest single DPNA in the dataset ran 458 days.

Does a DPNA affect residents already in the nursing home?

No. A DPNA only prevents the nursing home from accepting new Medicare-paying admissions. CMS cannot immediately remove existing residents, and the facility continues caring for them. The ban reduces census growth, which creates financial pressure without displacing current residents.

Which states have the most nursing home payment denials?

IL leads with 299 facilities subject to DPNAs across 500 actions in the three-year window. CA is second with 211 facilities. State totals reflect both enforcement intensity and total facility count — larger states tend to have more DPNAs in absolute terms.

Can a nursing home get a DPNA more than once?

Yes. 442 of the 1,950 banned facilities had more than one DPNA action in the three-year window. The facility with the most received 6 separate actions. Repeat DPNAs typically signal systemic noncompliance rather than isolated survey failures.

Where can I find nursing home DPNA data?

CMS publishes the NH Penalties file in the Provider Data Catalog. It contains every enforcement action including DPNAs, civil monetary penalties, and temporary manager appointments. Fonteum's research page provides a named list of affected facilities, state rankings, and the SQL to reproduce every figure.

Fonteum · Learn · Updated 2026-05-08

Nursing Home Medicare Payment Denials (DPNA): What They Are and How Often They Happen

A Denial of Payment for New Admissions (DPNA) is a Medicare enforcement action under 42 CFR §488.417 where CMS bars a nursing home from billing Medicare for new residents until it returns to compliance. CMS imposed DPNAs on 1,950 distinct US facilities across 2,553 separate actions in the three-year window ending 2026-03-06.

What a DPNA is

The DPNA is one of several enforcement remedies CMS can impose on a Medicare-certified nursing home that fails to meet federal participation requirements (42 CFR Part 483). When a survey finds immediate jeopardy deficiencies — conditions that cause or are likely to cause serious harm or death — CMS can simultaneously impose a DPNA and a civil monetary penalty. The DPNA takes effect immediately; the facility cannot admit any new Medicare beneficiaries until a resurvey confirms compliance.

The sanction is financial by design. A nursing home that cannot admit new Medicare residents loses revenue as its census declines. That revenue loss is meant to motivate rapid corrective action. Current residents are not displaced — they continue to receive care and their Medicare coverage is unaffected.

CMS nursing home enforcement remedies

Penalty	Abbr.	Mechanism	Typical trigger
Denial of Payment for New Admissions	DPNA	Blocks Medicare billing for new admissions	Facilities with immediate jeopardy or sustained noncompliance
Civil Monetary Penalty	CMP	Per-day or per-instance dollar fine	Any level of deficiency; scales with severity
Temporary Manager	TM	CMS-appointed manager oversees operations	Facilities with severe governance or staffing failures
Directed Plan of Correction	DPOC	CMS prescribes specific corrective steps	Facilities that fail to correct deficiencies on their own plan
Termination	Term.	Removes Medicare/Medicaid certification entirely	Facilities that cannot or will not achieve compliance

Source: 42 CFR §488.406 (alternative remedies), §488.417 (DPNA), §488.408 (CMPs). CMS may impose multiple remedies simultaneously.

DPNA enforcement data from CMS

1,950

facilities banned

2,553

separate actions

28 days

average ban length

442

repeat-DPNA facilities

Three-year rolling window (2023-05-05 – 2026-03-06). Source: CMS NH Penalties file, dataset g6vv-u9sr, pulled 2026-05-08.

View named facilities and state breakdown

States with the most DPNA actions

IL leads with 299 facilities and 500 separate actions — more than any other state by a significant margin. CA is second with 211 facilities. State rankings reflect both enforcement activity and total facility count; states with large nursing home populations naturally see more total DPNAs.

State	Facilities	Actions	Avg. ban (days)
IL	299	500	31
CA	211	285	24
TX	147	169	19
OH	144	176	32
MI	123	173	24
MO	112	157	30
IA	71	85	28
WI	70	98	32
NC	69	86	32
MN	49	59	18

Top 10 states by facilities affected. Full state breakdown in the research study.

Frequently asked questions

What is a DPNA in a nursing home?: A DPNA (Denial of Payment for New Admissions) is a Medicare enforcement sanction under 42 CFR §488.417 where CMS bars a nursing home from billing Medicare for any resident admitted during the ban period. Current residents are unaffected. The DPNA ends when CMS resurveys the facility and confirms it has returned to compliance.
How does CMS decide to impose a DPNA?: CMS imposes a DPNA when a survey finds that a nursing home has immediate jeopardy deficiencies (severity G or higher) or sustained noncompliance across multiple surveys. The penalty is designed to pressure facilities into rapid correction — financial loss from the ban creates urgency to resolve deficiencies quickly.
How long does a nursing home Medicare payment ban typically last?: The average DPNA in the CMS three-year window lasted 28 days; the median was 19 days. Most bans are short because the goal is rapid return to compliance. A long tail exists — the longest single DPNA in the dataset ran 458 days.
Does a DPNA affect residents already in the nursing home?: No. A DPNA only prevents the nursing home from accepting new Medicare-paying admissions. CMS cannot immediately remove existing residents, and the facility continues caring for them. The ban reduces census growth, which creates financial pressure without displacing current residents.
Which states have the most nursing home payment denials?: IL leads with 299 facilities subject to DPNAs across 500 actions in the three-year window. CA is second with 211 facilities. State totals reflect both enforcement intensity and total facility count — larger states tend to have more DPNAs in absolute terms.
Can a nursing home get a DPNA more than once?: Yes. 442 of the 1,950 banned facilities had more than one DPNA action in the three-year window. The facility with the most received 6 separate actions. Repeat DPNAs typically signal systemic noncompliance rather than isolated survey failures.
Where can I find nursing home DPNA data?: CMS publishes the NH Penalties file in the Provider Data Catalog. It contains every enforcement action including DPNAs, civil monetary penalties, and temporary manager appointments. Fonteum's research page provides a named list of affected facilities, state rankings, and the SQL to reproduce every figure.

Related resources

Fonteum is a public-records evidence platform covering US, UK & Australia public records, plus global sanctions and entity identifiers, spanning healthcare, federal procurement, sanctions and watchlists, federal enforcement, intellectual property, securities filings, and global company registers. Production registry status is reported separately from loaded and fresh coverage. Dated platform counts come from the public platform-stats snapshot; source-file hashes are reported where present, and deterministic fact-to-signature linkage is not claimed.

Data: CMS NH Penalties file, dataset g6vv-u9sr, pulled 2026-05-08. US-Government-Works license.

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