The Centers for Medicare & Medicaid Services (CMS) on Friday introduced a set of revisions updating survey procedures to require more consistent onsite timelines and clearer revisit protocols, expand enforcement through strengthened Civil Money Penalties (CMPs), and refine definitions of Immediate Jeopardy (IJ) to better identify and respond to the most serious risks to residents.
With these updates, the federal agency said in a memo that it seeks to make surveys, enforcement, and dispute resolution simpler, clearer and more consistent.
These changes, reflected in updates to Chapters 5 and 7 of the State Operations Manual (SOM), aim to ensure that surveyors identify and respond to non-compliance more effectively.
These updates make oversight and investigations more uniform across the country. CMS will now require approval before any off-site investigation to ensure the same rules are applied everywhere. The changes also add clearer examples of serious situations.
“The revisions also expand examples of intakes that warrant immediate jeopardy prioritization, such as discharging a resident to an unsafe setting,” the memo said.
Changes to chapter 7 include revisit procedures for surveyors aimed at being clearer, whether surveyors return onsite or review off-site after finding non-compliance.
For more serious cases, or Immediate Jeopardy (IJ), CMS is revising guidance to surveyors on how to identify these risks, confirm when they’ve been corrected and adjust the severity rating once the danger is gone.
Facilities also will also have clearer rules for submitting an acceptable plan of correction after non-compliance – a step CMS has taken in response to recommendations made by the Office of Inspector General (OIG) to reduce confusion.
“[This addresses] an OIG recommendation to clarify areas related to the acceptable plans of correction after a facility was found to be non-compliant with the requirements for participation,” the memo stated.
Moreover, enforcement policies for Civil Money Penalties (CMPs) have been updated so that CMS can now apply per-instance or per-day fines, and the CMP Analytic Tool will reflect these updates starting March 31, 2026. Some penalties will also appear publicly on Nursing Home Care Compare starting June 24, 2026, the memo noted.
The Civil Money Penalty Reinvestment Program (CMPRI) has been updated too. The revised guidance clarifies the allowable and non-allowable uses of CMP funds, the current application review process, and reporting requirements for project results. Moreover, the State CMP Fund Balances from the State Plan will be publicly posted, the memo stated.
“Updates were made to strengthen the program’s capacity to support high-quality, resident-centered nursing home projects by encouraging more applications, ensuring accountability, and expanding access to funding” CMS noted.
Finally, the Informal Dispute Resolution (IDR) process has been aligned with the Independent IDR (IIDR) process, including guidance for uploading deficiencies into CMS systems, making the process more transparent and consistent.
The revisions also move the guidance on nurse staffing waivers and resident room variances outside of the survey process.
“This section of guidance simply provides a process for nursing homes to obtain a waiver and is not related to the survey process. Therefore, CMS is moving this guidance from Appendix PP to Chapter 7,” the CMS memo noted.
