; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers as published by the Centers for Medicare & Medicaid Services on September 16, 2016 (81 Fed. Reg. 63859); and (B) has in place alternative sources of energy capable of powering heating, ventilation, and air conditioning systems for at least 96 hours after a catastrophic natural disaster. ; and (4) by adding at the end the following new sentence: Nothing in paragraph (4)(B) shall be construed to require a nursing facility to continuously maintain a supply of fuel on its premise, as long as such facility is able to demonstrate to the Secretary the ability of the facility to obtain any fuel necessary to satisfy such paragraph. . (c) Civil money penalties (1) Increased penalty In the case of a determination to impose a civil money penalty under section 1819(h)(2)(B)(ii) of the Social Security Act ( 42 U.S.C. 1395i–3(h)(2)(B)(ii) ) or section 1919(h)(2)(C)(ii) of such Act ( 42 U.S.C. 1396r(h)(2)(C)(ii) ), with respect to a violation of paragraph (4) of section 1819(a) of such Act ( 42 U.S.C. 1395i–3(a) ) or of paragraph (4) of section 1919(a) of such Act ( 42 U.S.C. 1396r(a) ), as added by subsections (a) and (b), respectively, such penalty shall be three times the amount that would otherwise be imposed pursuant to the interim final rule, relating to the adjustment of civil money penalties for inflation, promulgated by the Department of Health and Human Services on September 6, 2016 (81 Fed. Reg. 61538). Nothing in this paragraph shall be construed as limiting the discretion of the Secretary of Health and Human Services in determining the amount of a civil monetary penalty that would otherwise be imposed before application of this paragraph. (2) Additional penalty (A) Medicare Section 1819(h)(2)(B)(ii) of the Social Security Act ( 42 U.S.C. 1395i–3(h)(2)(B)(ii) ) is amended— (i) in subclause (I), by inserting , subject to subclause (V), after exceed