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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15550805/18/2017FORM

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How to fill out immediate jeopardy

01

Identify the specific concern or violation that poses immediate jeopardy to the health and safety of individuals.

02

Notify appropriate authorities such as state agencies or accrediting bodies.

03

Develop a plan of correction that addresses the immediate jeopardy situation and prevents it from occurring again.

04

Implement the plan of correction and monitor its effectiveness.

05

Document all actions taken to address the immediate jeopardy situation.

Who needs immediate jeopardy?

01

Any individual or entity that provides healthcare services and is found to be in violation of regulations or standards that pose a threat to the health and safety of individuals may be deemed to have immediate jeopardy.

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What is immediate jeopardy?

Immediate jeopardy refers to a situation in which a provider's noncompliance with one or more Medicare requirements has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

Who is required to file immediate jeopardy?

Healthcare providers and facilities that participate in the Medicare program are required to file immediate jeopardy reports.

How to fill out immediate jeopardy?

Immediate jeopardy reports can be filled out by completing a CMS Form 2567 and submitting it to the appropriate state survey agency.

What is the purpose of immediate jeopardy?

The purpose of immediate jeopardy is to protect the health and safety of residents in healthcare facilities by requiring providers to address serious noncompliance issues promptly.

What information must be reported on immediate jeopardy?

Immediate jeopardy reports must include details of the noncompliance issue, the potential harm to residents, and the corrective actions taken by the provider.

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