CMS Revises Policy Regarding Imposition of Immediate Jeopardy Remedies

The Centers for Medicare and Medicaid Services (CMS) has issued a Quality, Safety and Oversight Memo (QSO 18-18) outlining changes to enforcement guidelines. In October 2017, CMS issued S&C 18-01, in draft, asking for comments on changes to the enforcement process. QSO 18-18 represents the revised final version related to Immediate Jeopardy (IJ) imposition. Most significant is that a Civil Money Penalty (CMP) is no longer a mandatory remedy in all instances. The revised guidance states the following:

When IJ is identified on the current survey that resulted in serious injury, harm, impairment or death, a CMP must be imposed. For IJ citations where there is no resultant serious injury, harm, impairment or death but the likelihood is present, the CMS RO must impose a remedy or remedies that will best achieve the purpose of attaining and sustaining compliance. CMPs may be imposed, but they are not required.

Remedies in place of the CMP might include a Directed Plan of Correction (DPOC), a Directed Inservice, or a number of other possible remedies designed to achieve correction. There are also some time frame changes included in the QSO revision.

While the revisions outlined in QSO 18-18 create some flexibility in the imposition of remedies and are designed to tailor enforcement remedies to specific situations, it was strongly opposed by a number of state attorneys general (including New York State), who sent a letter to CMS in opposition to the proposed CMP changes. 

Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832