CMS Updates Surveyor Guidance on Immediate Jeopardy

PUBLISHED: Mar 6, 2019
Relevant to: All Healthcare Organizations

The U.S. Centers for Medicare and Medicaid Services (CMS) has updated guidance for surveyors on Immediate Jeopardy (IJ), situations in which a recipient of care has suffered or is likely to suffer serious injury, harm, impairment or death as a result of a provider’s, supplier’s, or laboratory’s noncompliance with one or more health and safety requirements. According to CMS, IJ represents the most severe and egregious threat to the health and safety of recipients, as well as carries the most serious sanctions for providers, suppliers, and/or laboratories.

The updated guidance to surveyors for citing immediate jeopardy is applicable to all provider and supplier types. The revisions include subparts that are focus on specific concerns with nursing homes and clinical laboratories. The revisions include a template for surveyors to use to ensure that providers, suppliers, or laboratories are notified as soon as possible of an immediate jeopardy finding. This process is intended to increase transparency, and improve timeliness and clarity of communication to providers, suppliers, and laboratories.

While this guidance is intended for surveyors, it is helpful for providers, suppliers, and laboratories to understand what surveyors are looking for and how they will cite IJs. According to the updated guidance, in order to cite immediate jeopardy, pursuant to Core Appendix Q guidelines, surveyors must determine that:

  • Noncompliance occurred; and,
  • The noncompliance caused or created a likelihood that serious injury, harm, impairment or death to a recipient would occur or recur; and
  • Immediate action is necessary to prevent the occurrence or recurrence of serious injury, harm, impairment or death to one or more recipients.

The Core Appendix Q contains several key changes from the previous version of Appendix Q. Those changes include:

  • Likelihood instead of potential: The previous version of Appendix Q suggested that a potential for serious harm might constitute immediate jeopardy. Core Appendix Q makes it clear that in order to cite immediate jeopardy in situations where recipients have not already suffered serious injury, harm, impairment or death, the nature and/or extent of the identified noncompliance creates a likelihood (reasonable expectation) that such harm will occur if not corrected, not simply the potential for that level of harm to occur.
  • Culpability has been removed: The previous version of Appendix Q made culpability a required component to cite immediate jeopardy. Because the regulatory definitions of immediate jeopardy do not require a finding of culpability, that requirement has been removed and has been replaced with the key component of noncompliance, since the definitions of immediate jeopardy require noncompliance to be the cause of the serious injury, harm, impairment or death, or the likelihood thereof.
  • Psychosocial harm: Core Appendix Q includes a section instructing surveyors to consider whether noncompliance has caused or made likely serious mental or psychosocial harm to recipients. In situations where the psychosocial outcome to the recipient may be difficult to determine or incongruent with what would be expected, the guidance instructs surveyors to use the reasonable person concept to make that determination. The reasonable person approach considers how a reasonable person in the recipient’s position would be impacted by the noncompliance (i.e. consider if a reasonable person in a similar situation could be expected to experience a serious psychosocial adverse outcome as a result of the same noncompliance).
  • No automatic immediate jeopardy citations: Core Appendix Q makes it clear that each immediate jeopardy citation must be decided independently and there are no automatic immediate jeopardy citations.

Follow the link below to the revised surveyor guidance.

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