New Remedies Procedures for Nursing Homes to Take Effect

CMS posted a new survey and certification letter outlining new procedures for survey enforcement penalties, which will take effect on September 1^st. The CMS regional office will now automatically impose a remedy, with no opportunity to correct, when actual harm (G) or Substandard Quality of Care (SQC) is cited. The letter also states that CMS will automatically assess civil monetary penalties for Immediate Jeopardy citations, however that is already standard practice. Read the S and C letter.

View a summary from LeadingAge National.

The following revised policies are effective for all surveys completed on or after September 1, 2016.

Chapter 7 is revised to define new mandatory criteria for immediate imposition of federal remedies prior to affording a facility an opportunity to correct deficiencies.

o    “The State Survey and/or Medicaid Agencies shall not permit changes to this policy and shall not offer a facility an opportunity to correct cited deficiencies before federal remedies are imposed if the situation meets the criteria in §7304.1.”:

• Immediate Jeopardy (IJ) (scope and severity levels J, K, and L) is identified on the current survey; OR
• Deficiencies of substandard quality of care (SQC) that are not IJ are identified on the current survey; OR
• Any G level [actual harm] deficiency is identified on the current survey at §483.13, Resident Behavior and Facility Practices,; §483.15, Quality of Life; or §483.25, Quality of Care; OR
• Deficiencies at G or above are determined on the current survey [with] deficiencies at G or above on the previous standard health or LSC survey OR deficiencies at G or above on any type of survey between the current survey and the last standard survey. These surveys must be separated by a period of compliance (i.e., from different noncompliance cycles).; OR
• A facility is classified as a Special Focus Facility (SFF) AND has a deficiency citation at level “F” or higher on its current survey.

Section 7400.5.1 – Factors That Must Be Considered When Selecting Remedies, and the Assessment Factors Used to Determine the Seriousness of Deficiencies Matrix has been revised:

(a) Initial assessment. In order to select the appropriate remedy, if any, to apply to a facility with deficiencies, CMS and the State determine the seriousness of the deficiencies.

(b) Determining seriousness of deficiencies. CMS considers and the State must consider at least the following factors:

(1) Whether a facility’s deficiencies constitute—

(i) No actual harm with a potential for minimal harm;

(ii) No actual harm with a potential for more than minimal harm, but not immediate jeopardy;

(iii) Actual harm that is not immediate jeopardy; or

(iv) Immediate jeopardy to resident health or safety.

(2) Whether the deficiencies—

(i) Are isolated;

(ii) Constitute a pattern; or

(iii) Are widespread.

(c) Other factors which may be considered in choosing a remedy within a remedy category. Following the initial assessment, CMS and the State may consider other factors, which may include, but are not limited to the following:

(1) The relationship of the one deficiency to other deficiencies resulting in noncompliance.

(2) The facility’s prior history of noncompliance in general and specifically with reference to the cited deficiencies.

• S/S citations at levels A, B and C now all indicate no remedies are required;
• Termination and Temporary Management have been added as possible remedies under Category 2.

Effective Dates are Clarified:

o   Once a remedy is imposed, it is in effect as of the date in the notice letter (i.e., as soon as the minimum notice requirements are met). All remedies remain in effect and continue until the facility is in substantial compliance.  “… Substantial  compliance must be verified in accordance with §7317 of this Chapter….”

o   For Immediate Jeopardy Situations, removal of the IJ may, at CMS’s discretion, result in rescission of the 23­day termination imposed, but once minimum notice requirements are met, CMS shall not rescind any remedies imposed.

• Remedies will be immediately imposed and effectuated whether or not the immediate jeopardy was:
• past noncompliance, or,
• removed during the survey, or,
• removed in a subsequent IJ-removal revisit before the 23rd day.