Final Revised Policies Regarding the Immediate Imposition of Federal Remedies Chapter 7 of the State Operations Manual

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

CMS has posted QSO 18-18-NH with this summary:

Memorandum.jpg

The 3-page memorandum is followed by 15 pages of the revised Chapter 7 of the State Operations Manual (SOM). These pages are an Advance Copy of the revisions and thus have no effective or implementation dates at this time.   The revisions on this advance copy are identified in red ink.

“Revisions to Chapter 7 of the State Operations Manual (SOM), Chapter 7 – Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities (Attachment)

  • CMS has revised guidance relating to the Immediate Imposition of Federal Remedies in Chapter 7 of the SOM as reflected in the advanced copy attached to this memo. Substantive revisions to the prior Immediate Imposition of Federal Remedies guidance S&C: 16-31-NH include:
  • When the current survey identifies Immediate Jeopardy (IJ) that does not result in serious injury, harm, impairment or death, the CMS RO must immediately impose a remedy. Some of the possible remedies include a civil money penalty (CMP), directed in service training, directed plan of correction. A complete list of enforcement remedies can be found at https://www.gpo.gov/fdsys/pkg/CFR-2014-title42-vol5/pdf/CFR-2014-title42-vol5-sec488-408.pdf;
  • Clarifying that Past Noncompliance deficiencies (as described in §7510.1 of Ch. 7 of the State Operations Manual (i.e. Determining Citations of Past Noncompliance at the Time of the Current Survey) are not included in the criteria for Immediate Imposition of Remedies; and,
  • For SFFs, scope/severity level “F” citations under tags F812, F813 or F814 are excluded from immediate imposition of remedies. The complete list of all F-Tags is located at: https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/GuidanceforLawsAndRegulations/Downloads/List-of-Revised-FTags.pdf

Other sections of Chapter 7 have been revised to ensure conformity and consistency with these revisions. Specifically, the following sections, which include previous language that has been renumbered, moved and/or consolidated to provide better organized guidance:

  • §7205 – Survey Frequency: 15-Month Survey Interval and 12-Month Statewide Average
  • §7205.1 – Last Day of Survey
  • §7205.1.1 – Setting the Mandatory 3-Month and 6-Month Sanction Time Frames
  • §7310 – Immediate Jeopardy (IJ) Does Not Exist
  • §7317 – Acceptable Plan of Correction
  • §7400.4 – Other Factors That May Be Considered in Selecting Enforcement Remedy Within a Remedy Category
  • §7510.1 – Determining Citations of Past Noncompliance at the Time of the Current Survey

The final version of these revisions to Chapter 7, when published in the SOM may differ slightly from this attached interim advanced copy.”

Briggs Healthcare® will continue to monitor the State Operations Manual – CMS website for posting of the final revised Chapter 7. We’ll provide notice when the final revised Chapter has been posted.