CMS policy to require immediate enforcement remedies for SNFs, NFs, SNF/NFs

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The Centers for Medicare & Medicaid Services (CMS) is implementing a national policy for skilled nursing facilities (SNFs), nursing facilities (NFs) and dually participating facilities (SNF/NFs) that requires the use of federal enforcement remedies when one or more residents suffer significant harm.

CMS will immediately impose civil money penalties (CMPs) any time immediate jeopardy (IJ) is cited.
Under the new policy, regardless of a state recommendation to impose or not impose a remedy, the CMS regional office 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) as outlined in Chapter 7 of the State Operations Manual.

CMS is specifying the responsibilities of the state survey agencies and the regional offices when there is an immediate imposition of federal remedies. When a facility is not allowed an opportunity to correct deficiencies prior to the immediate imposition of federal remedies:

  • The survey agency (state or federal) must enter all of these cases into the Automated Survey Processing Environment (ASPEN)/ASPEN Enforcement Manager (AEM) system as a “No Opportunity to Correct” case within five business days from when the initial notice was sent to the facility.
  • The state must transfer these cases to the regional office for their review and imposition of federal remedies.
  • The regional office must take action to impose remedies as described in policy, regardless of a state’s recommendation and must consider the seriousness of the deficiencies.

The policy is for all surveys completed on or after Sept 1.