On June 15, 2018, the Centers for Medicare & Medicaid (“CMS”), Center for Clinical Standards and Quality/Quality, Safety & Oversight Group (“QSO”) issued a Memorandum (“Memo”) with Final Revised Policies Regarding the Immediate Imposition of Federal Remedies (QSO 18-18-NH). The revised policies become effective July 15, 2018 and replace a July 22, 2016 Memorandum.
The Final Revised Policies apply to all Medicare and Medicaid participating skilled nursing facilities, nursing facilities and dually participating facilities. When a facility is determined to be out of compliance with its obligation to maintain certain health and safety standards for residents, CMS is statutorily mandated to impose remedies. The Memo clarifies that CMS Regional Offices (“RO”) do consider the extent to which any noncompliance is a one-time incident or mistake, or intentional or systemic. When facilities are out of compliance with the statutory standards, the states must refer case information to the RO for enforcement action.
The main substantive changes contained in the June 15, 2018 Memo are:
- When the violation of health and safety standards involves “Immediate Jeopardy” that does not result in serious injury, harm, impairment, or death to a resident, the RO must immediately impose a remedy. Possible remedies include a civil money penalty, training, or a directed plan of correction. If Immediate Jeopardy does result in serious injury, harm, impairment, or death—a civil money penalty must be imposed. Immediate Jeopardy is defined as “A situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.” See 42 CFR Part 489.3. Although a State Survey Agency may recommend remedies to the RO, the RO must impose a remedy or multiple remedies, based on the seriousness of the deficiencies.
- Past Noncompliance deficiencies (described in § 7510.1 of Chapter 7 of State Operations Manual – are not included in the criteria for Immediate Imposition of Remedies.The determination to impose a federal remedy for past noncompliance is not mandatory and is at the discretion of the RO.
- For Special Focus Facilities, higher scope and severity harm level “F” deficiencies are excluded from immediate imposition of remedies. (under F812, F813, or F814).
For more information regarding this Memo and links to important resources, click here.