Revisions to Appendix Q, Guidance on Immediate Jeopardy
• Core Appendix Q and Subparts - Appendix Q to the State Operations Manual (SOM), which provides guidance for identifying
immediate jeopardy, has been revised. The revision creates a Core Appendix Q that will be used by surveyors of all provider
and supplier types in determining when to cite immediate jeopardy. CMS has drafted subparts to Appendix Q that focus on immediate
jeopardy concerns occurring in nursing homes and clinical laboratories since those provider types have specific policies related
to immediate jeopardy.
• Key Components of Immediate Jeopardy – To cite immediate jeopardy, surveyors determine that (1) noncompliance (2) caused
or created a likelihood that serious injury, harm, impairment or death to one or more recipients would occur or recur; and
(3) immediate action is necessary to prevent the occurrence or recurrence of serious injury, harm, impairment or death to
one or more recipients.
•Immediate Jeopardy Template – A template has been developed to assist surveyors in documenting the information necessary
to establish each of the key components of immediate jeopardy. Survey teams must use the immediate jeopardy template attached
to Appendix Q to document evidence of each component of immediate jeopardy and use the template to convey information to the