In February 2026, and then again in April 2026, the Centers for Medicare & Medicaid Services (CMS) issued revisions to two chapters of the State Operations Manual, Chapter 5 and Chapter 7. These updates can be found in a QSO Memo with the same name. We’ll review some important information from Chapter 5 in this post, and you can look for an accompanying post for Chapter 7 on the CMSCG Blog shortly.
Per the Memo, Chapter 5 was updated to include:
- Revisions to Immediate Jeopardy Priority Definition examples for Nursing Homes
- Clarification of Off-Site Investigations related to Complaints
Immediate Jeopardy
State Operations Manual Chapter 5 Section 5075.1 addresses Immediate Jeopardy for Nursing Homes and some other providers. In the February updates to this Chapter of the SOM, CMS added additional information about the intake priority for complaints which could be immediate jeopardy. The following must be prioritized as immediate jeopardy:
- All intakes which allege abuse of a patient/resident that involve serious injury, harm, impairment or death or the likelihood for such where it is uncertain that the patient/ resident is adequately protected.
- All intakes where a resident was discharged to an unsafe setting or where a resident was discharged in a manner that placed the resident at risk for serious harm
Administrative Review/ Offsite Investigation
For nursing homes, per the February 2026 revisions to Section 5075.5, State Agencies may conduct a review/offsite investigation and confirm their findings at the next on-site survey. The Manual was updated to state that offsite investigations are not permitted unless approved in advance by CMS.
Nursing Home Complaint Investigations
Addressed in Section 5300 of SOM Chapter 5, new information about survey time was added in the April 2026 revisions. Specifically, it now states that abbreviated surveys must be conducted on two consecutive calendar days from the entrance date. The only exceptions to this would be if there was a situation deemed an “emergency” by the State Agency (SA) or a “competing IJ” at another facility occurred and surveyors needed to prioritize that one.
The Exit Conference
Another section that was updated in February is 5300.5. There are two instances where the survey team is instructed to provide additional information which have been clarified:
- Past Noncompliance – If a deficiency is not present at the exit, but was present and has been corrected, then the facility should be notified orally and in writing that there was noncompliance related to the complaint.
- No Noncompliance – If there was no noncompliance observed related to the complaint, then the facility should be notified.
Section 5330 Reporting Abuse to Law Enforcement and the Medicaid Fraud Control Unit for Nursing Homes was updated in February 2026 as well. If the State Agency or CMS location confirms noncompliance related to abuse, then it must report the cited finding of noncompliance to local law enforcement, and if appropriate, the Medicaid Fraud Control Unit.
View CMS QSO Memo Ref: QSO-26-03-NH and QSO-26-03-NH (REVISED) for more details and to download the manuals.
