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CMS Revises Appendix Q Guidance on Immediate Jeopardy

The Centers for Medicare & Medicaid Services (CMS) has finally released the long anticipated revisions to Appendix Q of the State Operations Manual (SOM) which provides guidance on identifying immediate jeopardy situations. The new QSO memo applies to all provider types, but includes additional information for LTC surveyors. Updates to Appendix Q include:

  • In order to cite immediate jeopardy where residents have not already suffered serious injury, harm, impairment or death, surveyors are guided to determine if the nature and/or extent of the identified noncompliance creates a likelihood that such harm will occur if not corrected, not just identify if the potential for the level of harm will occur. CMS clarifies this as “likelihood instead of potential.”
  • In order to cite immediate jeopardy, surveyors will no longer be required to find culpability since this is not included in the regulatory definitions of immediate jeopardy. Instead, surveyors are guided to identify the key component of noncompliance, which is the cause of serious injury, harm, impairment or death, or the likelihood of one of these.
  • The updates to Appendix Q also instruct surveyors to consider whether noncompliance has caused or made likely serious mental or psychosocial harm to residents. In situations where a psychosocial outcome may be difficult to determine, surveyors are guided to use the reasonable person concept. This is the idea that takes into account how a reasonable person who was in the recipient’s position may be impacted by noncompliance, including if that person would be expected to experience a serious psychosocial adverse outcome due to that noncompliance.   
  • There are no “automatic” immediate jeopardy citations and each immediate jeopardy citation must be decided independently.
  • Surveyors must use the Immediate Jeopardy Template to identify IJ situations and follow the process to ensure timely notification to providers about potential immediate jeopardy findings.

Read the March 5, 2019 QSO Memo, “Revisions to Appendix Q, Guidance on Immediate Jeopardy” (Ref: QSO-19-09-ALL).

Our prior series from 2012 on Immediate Jeopardy in Nursing Homes has been the most downloaded information on the CMS Compliance Group website. CMS Compliance Group will be providing in-depth information for providers on the revisions to Appendix Q guidance, so stay tuned for a link to download.  CMSCG’s consultants have extensive experience in helping clients remedy immediate jeopardy situations in nursing homes – if your facility requires assistance, please contact us.

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