CMS Revises Immediate Jeopardy Citation Process

The U.S. Centers for Medicare & Medicaid Services (CMS) will now require its surveyors to report suspected crimes to local law enforcement, such as patient abuse, theft, sexual assault or other unlawful activity.

The agency inserted new language into Appendix Q of its State Operations Manual that in addition to the law enforcement requirement lays out new and clarified guidelines for when surveyor should cite an immediate jeopardy finding and contains a standardized tool in which surveyors will document such incidents. 

“Immediate Jeopardy represents a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death,” according to CMS. “These situations must be accurately identified by surveyors, thoroughly investigated, and resolved by the entity as quickly as possible. In addition, noncompliance cited at [immediate jeopardy] is the most serious deficiency type, and carries the most serious sanctions for providers, suppliers, or laboratories (entities).”


When surveyors find an immediate jeopardy situation, they are required to notify CMS. The cited organization must take immediate action to eliminate the safety risk. Following that, the hospice would be required to submit a plan of correction to their state agency, showing how they will prevent similar incidents from recurring.

The agency previously revised immediate jeopardy guidelines in March, advising surveyors to consider the likelihood that the identified condition could harm patients, rather than just the potential for harm. The March revisions also made it unnecessary for the surveyors to determine culpability for the condition and requires them to take the likelihood of psychosocial harm in addition to physical harm.

Though the new revisions apply to all CMS-certified health care organizations and is not targeted towards hospice, the move comes at a time when federal agencies and legislators are calling for increased regulatory enforcement for the hospice industry in the aftermath of two scathing reports about deficiencies in the hospice space from the U.S. Department of Health and Human Services Office of the Inspector General.


“These cases reveal vulnerabilities in CMS’s efforts to prevent and address harm that have implications for the wider hospice population,” OIG reported. “These vulnerabilities include insufficient reporting requirements for hospices, limited reporting requirements for surveyors, and barriers that beneficiaries and caregivers face in making complaints. Also, these hospices did not face serious consequences for the harm described in this report.”