![]() The SSA requires any nursing home that does not achieve substantial compliance with the Federal requirements within six months be terminated from participation in Medicare and/or Medicaid. The survey agency determines the scope and severity levels for each deficiency cited at a survey. There are three scope levels assigned to a deficiency: isolated, pattern, or widespread. The scope level of a deficiency reflects how many residents were affected by the deficiency. Immediate jeopardy means a situation in which the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident. The severity harm levels are described as: no actual harm with potential for minimal harm no actual harm with a potential for more than minimal harm that is not immediate jeopardy actual harm that is not immediate jeopardy and immediate jeopardy to resident health or safety. The severity level reflects the impact of the deficiency and is categorized by four levels of harm. In order to select the appropriate enforcement remedy(ies), the scope and severity levels of the deficiencies must be assessed. The agency that conducts the on-site surveys cites deficiencies that indicate the specific Federal requirements that the facility did not meet. The statutory and regulatory requirements found in the Social Security Act (SSA) and the Code of Federal Regulations (CFR), provide that CMS or the State may impose one or more remedies when a facility is out of compliance with Federal requirements. Surveys are conducted on a 9 to 15 month cycle with a statewide average of 12 months.Įnforcement actions taken against nursing homes that are not in compliance with Federal requirements are called remedies. The Secretary of the United States Department of Health & Human Services has delegated to the CMS and the State Medicaid Agency the authority to impose enforcement remedies against a nursing home that does not meet Federal requirements.Įach of the 50 States, Puerto Rico and the District of Columbia has an agency that conducts on-site surveys for CMS to determine whether nursing homes are complying with Federal requirements. Nursing homes, which include Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs), are required to be in compliance with Federal requirements to receive payment under the Medicare or Medicaid programs. This page provides general information regarding enforcement actions that The Centers for Medicare & Medicaid Services (CMS) may take when a nursing home is not in compliance with Medicare or Medicaid requirements.
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