Breaking Down a Nursing Home’s Immediate Jeopardy: Pt. 4

In Part 3 of our series on Immediate Jeopardy situations in nursing homes, we discussed the less severe remedies that can be imposed by the CMS or the State. In the final part of our series, we will take a look at Category 3 remedies, which include:

  • Civil monetary penalties (both Category 2 and 3)
  • Temporary management (Category 3)
  • Immediate termination (Category 3)

The remedies will be selected based upon the severity of noncompliance, so if your facility is in Immediate Jeopardy, Category 3 remedies will be imposed. Let’s take a look at Category 3 remedies in more detail.

Part 4: Non-Compliance & Category 3 Remedies

Temporary Management

A Category 3 remedy, temporary management (42 CFR 488.415) is when CMS or the State appoints a temporary administrator or facility manager to oversee operations of the facility and corrected the identified deficiencies. The temporary manager has the ability to terminate or reassign staff, update your facility’s procedures and re-appropriate facility funds in order to address the Immediate Jeopardy. Your facility will be responsible for paying the salary for this temporary manager. If you do not allow the temporary manager to oversee your facility, your provider agreement will be terminated immediately.

Civil Monetary Penalties

CMS or the State may impose civil monetary penalties based on the number of days your facility is out of compliance per instance in addition to termination and/or temporary management (SOM 7400.6.3). The daily amount of the penalty will vary, but for Immediate Jeopardy situations, penalties will occur in the $3,050-$10,000 range (42 CFR 488.438).

Termination of Provider Agreement

As you are aware, termination will go into effect on the 23rd calendar day if the Immediate Jeopardy has not been removed.

Termination brings about several situations including the transfer of residents or closure of your facility. If your facility’s provider agreement is terminated, the State will arrange for transfer of all Medicare and Medicaid residents to a different facility (SOM 488.426). CMS and the State must provide 2 calendar days’ notice before the effective date of your facility’s termination in Immediate Jeopardy situations.


Deficiencies that lead to Immediate Jeopardy situations are almost always preventable, so long as your facility takes a proactive view towards compliance. Category 3 remedies will be imposed when your skilled nursing facility’s deficiencies are significant enough that they cause an Immediate Jeopardy.  It’s important to continually review and update your policies and procedures, provide training and education to all staff, and foster an environment where issues can be discussed and addressed rather than swept under the rug. If you would like additional information on how to prepare your facility for survey, or address potential Immediate Jeopardy situations, please contact us and we will be happy to discuss.


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