On January 30, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum announcing revisions to Chapters 5 and 7 of the State Operations Manual (SOM). The updated guidance is effective March 30, 2026, and CMS directed that the information be communicated to appropriate staff within 30 days.
Revisions to Chapter 5 focus on oversight and investigation processes related to alleged noncompliance in nursing homes. CMS updated examples used to determine Immediate Jeopardy (IJ) priority, including situations such as discharging a resident to an unsafe setting. The revisions also clarify that off-site investigations must be approved by CMS in advance to ensure consistent application across states.
Chapter 7 was substantially updated to standardize survey and enforcement processes and to consolidate guidance previously found in Appendix P of the SOM. The revisions address a wide range of topics, including survey team composition, survey procedures, plans of correction, verification of corrections, survey revisits and off-site paper reviews, off-hours surveys, enforcement actions, nurse staffing waivers, and the disposition of civil money penalties (CMPs). Technical updates were also made to ensure references throughout the chapter are accurate.
Guidance on IJ was updated to clarify how it is identified, how surveyors determine when it has been removed, and conditions under which the severity of a deficiency may be reduced once IJ is abated. The revisions also clarify expectations for acceptable plans of correction in response to Office of Inspector General (OIG) recommendations.
Enforcement updates revise CMP policies to reflect current practices, including the use of the CMP Analytic Tool and annual inflation adjustments under the Federal Civil Penalties Inflation Adjustment Act. Changes aligned with the Fiscal Year 2025 Skilled Nursing Facility Prospective Payment System final rule expand CMS’s ability to impose per-instance and per-day CMPs to support sustained correction of deficiencies.
Updates to the Civil Money Penalty Reinvestment Program clarify allowable and non-allowable uses of CMP funds, application review procedures, and reporting requirements for funded projects. The revisions also state that state CMP fund balances will be publicly posted. Guidance on Informal Dispute Resolution (IDR) was updated to align with the Independent Informal Dispute Resolution (IIDR) process and to include instructions for documenting deficiencies pending IDR or IIDR in CMS record-keeping systems.
Compliance Perspective
Issue
CMS has released revisions to Chapters 5 and 7 of the SOM, updating guidance on survey, oversight, enforcement, and IJ procedures. The updates clarify off-site investigations, acceptable plans of correction, enforcement actions, and processes related to CMPs and IDR. Facilities should review their current policies, training, and audit practices to ensure they reflect the updated SOM guidance and support compliance.
Discussion Points
- Review and update policies and procedures to align with the SOM revisions, including procedures for identifying and responding to IJ, off-site investigations, and CMP use. Facilities may consider collaborating with an external consultant to assess whether existing policies adequately address the revised oversight and enforcement expectations, plan of correction processes, and compliance with prior survey findings.
- Provide staff education on key updates, including identifying IJ, understanding enforcement processes, and proper documentation for surveys and IDR submissions. Med-Net Academy offers the course Understanding and Writing an Acceptable Plan of Correction, which teaches participants how to develop compliant POCs, including corrective actions, identifying affected residents, prevention strategies, monitoring, and completion timelines. The course also reviews CMS survey types, scope and severity levels, and the role of Form CMS-2567. Another course, Immediate Jeopardy – How It Is Determined and Areas at Risk, covers how survey teams identify noncompliance, determine when it constitutes IJ, recognize serious adverse outcomes or negative psychosocial impacts, develop IJ removal plans, and identify situations requiring further investigation.
- Conduct audits to identify potential compliance gaps in areas addressed by the SOM revisions, such as IJ identification, off-site investigation documentation, or CMP reporting. Facilities may consider engaging external expertise for targeted mock surveys or compliance reviews to proactively detect gaps and ensure corrective actions are effective before official surveys occur.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*