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The Centers for Medicare & Medicaid Services (CMS) issued a Survey and Certification Letter on October 27, 2017, which outlined proposed changes to Chapter 7 of the State Operations Manual (SOM), and invited public comment. As the Center for Medicare Advocacy noted in a previous alert, the proposed changes sought to reverse surveyor guidance issued by the Obama Administration in 2016 and to make changes to federal enforcement policy that would:

  • Create a distinction between different types of immediate jeopardy that does not exist in federal regulations;
  • Allow CMS Regional Offices (ROs) to lower per day Civil Money Penalties (CMPs);
  • Allow CMS ROs to select remedies for deficiencies without regard to the scope and severity of the facility’s noncompliance (in a manner that seemingly violates federal regulations); and
  • Allow CMS ROs discretion in determining whether to apply the immediate imposition of remedies at all for past noncompliance.

The Center for Medicare Advocacy and the Long Term Care Community Coalition submitted joint comments on November 22, 2017, expressing our opposition to CMS’s proposed changes and arguing that such changes could lead to a greater risk of resident harm. Unfortunately, CMS has chosen to move forward with their proposal. On June 15, 2018, CMS issued a Quality, Safety & Oversight (QSO, former S&C) Letter that made the proposed changes final.

While CMS has made some minor adjustments to the language in the proposed revisions, the overall impact that these changes could have on resident care and quality of life remain the same.

June 21, 2018 – D. Valanejad

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