Immediate Jeopardy Exists

7301.1 - Immediate Jeopardy Exists (Rev. 244; Issued: 06-26-26; Effective: 06-26-26; Implementation: 06-26-26) (See also §7307 and Appendix Q of this manual.) When immediate jeopardy exists: 1. The CMS Location or State Medicaid Agency will impose termination and/or temporary management in as few as 2 calendar days (one of which must be a working day) after the survey which determined immediate jeopardy. In all cases of immediate jeopardy, the provider agreement must be terminated by CMS or State Medicaid Agency no later than 23 calendar days from the last day of the survey if the immediate jeopardy is not removed. 2. The CMS Location or State Medicaid Agency should impose another remedy in addition to termination when immediate jeopardy has been determined. Immediate imposition of an alternative remedy should be considered even if the facility successfully removes the immediate jeopardy but is still not in substantial compliance. 3. The CMS Location or State Medicaid Agency may impose a (CMP) between $3,050 and $10,000 per day of immediate jeopardy or a “per instance” civil money penalty from $1,000 to $10,000 for each instance of noncompliance, or both per day and per instance CMPs may be imposed for the same survey (as adjusted for inflation under 45 CFR 102.3). The specific procedures for CMPs can be found in §7510-§7536. In cases when multiple per instance civil money penalties are imposed for a survey, the total dollar amount of all civil money penalties for noncompliance on any single day may not exceed the statutory and regulatory maximum amount and may not be less than the applicable statutory and regulatory minimum amount for each day. When multiple per instance civil money penalties are imposed for different days of noncompliance, the total amount of all civil money penalties imposed for the survey may exceed the statutory and regulatory maximum (the statutory maximum only applies to the civil money penalty amount for any single day). Examples: A) F-tags F686 & F689 were cited on a survey and the noncompliance occurred on the same day. A per instance civil money penalty of $5,000* is imposed for F686 and a per instance civil money penalty of $5,000* is imposed for F689. No civil money penalty could then be imposed for additional deficiencies on that day because the total civil money penalty, consisting of any per instance and/or per day civil money penalties, must not exceed the statutory and regulatory maximum for each day. B) F-tags F684 & F687 were cited on a survey and the noncompliance occurred on different days. A per instance civil money penalty of $10,000* is imposed for F684 and a per instance civil money penalty of $10,000* is imposed for F687. If noncompliance occurs on different days, two (or more) per instance civil money penalties at the maximum amount may be imposed for the same survey if the maximum statutory and regulatory amount is not exceeded for each day. C) F-tag F689 was cited on a survey and the noncompliance began two months prior to the start of the survey. A per instance civil money penalty of up to $10,000* may be imposed for noncompliance related to F689 that started prior to the survey start date. A per day civil money penalty may also be imposed for noncompliance related to F689 that exists beginning on the survey start date, and it would continue to accumulate per day until substantial compliance is achieved. *Note: The CMP amounts referenced in the examples above are noted as the original statutory maximum amounts per day. However, the current maximum amounts are adjusted annually for inflation and published in 45 CFR 102.3 as required under the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015. The amounts above are being used for illustrative purposes only. Federal CMPs are imposed in accordance with the instructions in the CMP Analytic Tool. 4. The CMS Location or State Medicaid Agency may impose other remedies as described in §7500. Except for State monitoring, which requires no notice, the CMS Location or State Medicaid Agency may impose remedies 2 calendar days (one of which must be a working day) from the date the facility receives notice. 5. The CMS Location, State Medicaid Agency, or State (as authorized by CMS) may impose State monitoring immediately without notice. 6. The State, as authorized by CMS, may also provide notice of the imposition of denial of payment for new admissions effective 2 calendar days (one of which must be a working day) from the date the facility receives notice. (See also §7314, and §7506.1.) 7. The State will require that the facility submit an allegation that the immediate jeopardy has been removed as well as provide sufficient detail to demonstrate how the immediate jeopardy has been addressed so that the State can verify onsite the removal of the immediate jeopardy. A plan of correction should be deferred until the facility has successfully demonstrated removal of immediate jeopardy. Facilities should be cautioned that the allegation of removal of the immediate jeopardy does not guarantee a revisit before the effective date of termination. 8. The State will require an acceptable plan of correction for all deficiencies cited after it conducts the revisit to confirm removal of the immediate jeopardy. 9. The State is authorized to recommend and impose category 1 remedies. When authorized by the CMS Location, the State may also provide notice of imposition and rescission of the denial of payment for new admissions remedy. (See also §7314 and §7506.1.)