CMS has released a revision to a memo it issued this spring on “Revisions to Appendix Q, Guidance on Immediate Jeopardy.” The revised memo adds language to Appendix Q to give state survey agencies guidance on when they must report suspected illegal acts to law enforcement. The language added to Appendix Q now specifies that when a deficiency is identified, if illegal activity is connected to the deficiency, the state surveyor and state survey agency have an obligation to report the illegal activity to law enforcement.

Specifically, CMS added the following language:

When the identified noncompliance is determined to have been caused by, or has led to a criminal act, reporting must be made to local law enforcement. If the entity refuses to report, or the surveyor cannot verify that a report was made to local law enforcement, the surveyor must consult with his/her supervisor immediately, and the State Agency must report the potential criminal incident to law enforcement immediately.

This change was likely in response to several recent reports from the Government Accountability Office and Office of Inspector General recommending steps CMS should take to address gaps in the agency’s oversight.

AHCA continues to monitor implementation of Appendix Q and appreciates any feedback sent to regulatory@ahca.org.

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Ref: QSO-19-09-ALL: Revisions to Appendix Q, Guidance on Immediate Jeopardy, Revised July 31, 2019