Revisions to Appendix Q: Guidance on Immediate Jeopardy

• By: Maureen Carland
• On: 12/05/2024 10:42:29
• In: Quality/Regulatory

The Centers for Medicare and Medicaid Services (CMS) issued QSO-25-09-ALL, revising Core Appendix Q in the State Operations Manual, which provides guidance for identifying Immediate Jeopardy (IJ). The revised Core Appendix Q is designed to standardize IJ determinations across all survey types.  The revisions include updated definitions and new tools, such as an IJ template, to assist surveyors in documenting findings.

Key changes include a shift from focusing on the “potential for serious harm” to requiring surveyors to establish that noncompliance caused or created a “likelihood” (reasonable expectation) of serious injury, harm, impairment, or death. The new guidance eliminates culpability as a required component for determining IJ, aligning instead with regulatory definitions that emphasize noncompliance as the root cause of harm or its likelihood. Additionally, the revisions include instructions for assessing psychosocial harm, using the "reasonable person" concept in cases where recipients' responses may be difficult to interpret due to cognitive or behavioral limitations. The reinstatement of reporting obligations to local law enforcement in cases involving suspected criminal acts.  

While these changes took effect with the November release, surveyors are required to complete new training available on the Quality, Safety, & Education Portal (QSEP) website to implement the guidance. Facilities and affected parties should familiarize themselves with these updates, including the IJ template, to prepare for upcoming surveys.

Staff contact: mcarland@mehca.org