CMS has issued updated guidance for surveyors and healthcare providers on addressing immediate jeopardy, the most severe type of noncompliance warning as the findings can place organizations at risk of losing federal funding.
Surveyors rely on CMS' Core Appendix Q guidance to evaluate all provider and supplier types when determining if an immediate jeopardy citation is warranted. The guidance underwent further updates to "clarify and increase consistency in identifying immediate jeopardy," CMS noted in its November memo.
Here are four significant updates to the guidance:
1. Clarifying the threshold for immediate jeopardy
Immediate jeopardy citations now require a "likelihood" of serious injury, harm, impairment or death if noncompliance is not corrected.
CMS defines "likelihood" as a "reasonable expectation" that serious harm will occur, replacing the broader "potential for harm" standard from the 2019 guidance.
2. Removing culpability as a required element
The updated guidance eliminates the need to establish "culpability" for immediate jeopardy findings.
Surveyors now focus solely on whether noncompliance has caused or is likely to cause serious harm, aligning with regulatory definitions that prioritize the role of noncompliance over assigning blame.
3. Emphasizing mental and psychosocial harm
Surveyors must evaluate whether deficiencies have caused or are likely to cause significant mental or psychosocial harm.
When it is unclear whether individuals have experienced serious psychosocial harm, surveyors should apply the "reasonable person" concept, according to the memo This approach considers how a reasonable individual in the recipient's position would be affected by the noncompliance.
4. Individualized citations
Immediate jeopardy citations are no longer automatic for any specific situation. Each citation must be assessed independently based on the facts and circumstances.