We learned that last Friday, July 22, 2016, the Centers for Medicare and Medicaid Services (CMS) released an advanced interim revision to the State Operations Manual (SOM), Chapter 7 with an “immediate effective date.”  It was accompanied by a memo explaining the changes to State Survey Agency Directors listing the effective date as, “For all surveys completed on or after August 1, 2016.”

It is our understanding that CMS intends to make additional changes to this latest revision to the SOM, but it is not clear whether such revisions would substantially modify the significant change articulated in the version we have already seen.  Because the implementation date is imminent, we thought it was important to share this draft with you now.

This draft revision to the SOM represents a marked expansion of the punitive enforcement process associated with survey citations.  The memo summarizes the revisions noting that:

Civil Money Penalties (CMPs) for Immediate Jeopardy (IJ): The CMS Regional Office (RO) must now immediately impose a CMP any time IJ is cited.

Immediate Imposition of Remedies Required: Irrespective of a state recommendation to impose or not impose a remedy, the CMS RO must immediately impose, without permitting a facility an opportunity to correct deficiencies, one or more federal remedies based on the seriousness of the deficiencies or when actual harm or Substandard Quality of Care (SQC) is identified as outlined in §7304.1.

As we learn more, we will provide you with additional information on this topic.

Resources

• Memorandum to State Agency Survey Directors: Mandatory Immediate Imposition of Federal Remedies and Assessment Factors Used to Determine the Seriousness of Deficiencies for Nursing Homes (S&C: 16-31-NH)
• Advanced Interim Revisions to the State Operations Manual (SOM 100-07) Chapter 7