Revisit/Dates of Compliance Policy
Questions & Answers
Return to DSL-BQA-01-028
Q1. If old deficiencies are corrected but new deficiencies are found
at the time of the 2nd or 3rd revisit, does a new
certification cycle begin with the new noncompliance?
A1. No. If noncompliance exists at the time of the 2nd or 3rd
revisit, it is considered to be continuing noncompliance regardless of
whether the previous deficiencies remain or new ones are cited, because it
is the whole facility, not just deficiencies, that factor into the
decision about a nursing home’s compliance status. In addition, the
timeframes for imposition of the mandatory denial of payment for new
admissions remedy and termination are not adjusted when there’s
continuing noncompliance.
Q2. If different Tags are cited at the 2nd or 3rd
revisit, would the new Tags be considered continuing noncompliance or new
noncompliance?
A2. Regardless of whether the new deficiencies are in the same or
different Tag(s) as those previously cited, the fact that noncompliance
exists at the time of the revisit constitutes continuing noncompliance.
Q3. Are revisits required to verify the removal of immediate
jeopardy?
A3. Yes.
Q4. Deficiencies involving quality of care should require a revisit
to verify correction. Why was that requirement removed in the final
policy?
A4. Revisits can be conducted anytime for any level of noncompliance.
While in the majority of cases, States may determine that an onsite
revisit is necessary to confirm compliance with deficiencies in quality of
care, some believe that there are instances when these issues can be
satisfactorily handled through acceptable evidence. Our policy preserves
that option.
Q5. According to the chart, a 3rd revisit is not
"required" to be performed. In cases when it is either not
performed by the State or not approved by the regional office, is it
correct that termination would proceed after the 2nd revisit?
A5. Yes. At the time of the 2nd revisit where noncompliance
continues to exist, the facility’s ability and/or willingness to achieve
compliance sometimes becomes debatable, and what should have been a
facility priority from the first survey of the cycle (i.e., achieving
compliance) does not translate into a priority for the survey agency to
perform a 3rd revisit.
Q6. If a 3rd revisit is not assured, how can States
fulfill HCFA’s policy that revisits must continue until compliance is
achieved or the facility is terminated when a survey finds noncompliance
at F (SQC), harm or immediate jeopardy?
A6. While the revised policy provides the expectation that revisits
will continue until compliance is achieved or termination occurs when SQC,
harm, or IJ is identified, it is important to remember that revisits are
not assured and, depending on the circumstances of any given situation,
termination can occur anytime for any level of facility noncompliance
without regard to revisits. Facilities have the responsibility to correct
their deficiencies and notify HCFA through an approved plan of correction
when that will be done. It is critical that facilities use revisits
sparingly so that the likelihood of needing additional ones is reduced. If
correction is not achieved at the expected time, the facility should
notify the State that correction has been delayed so that the revisit can
be delayed; otherwise revisits are performed by the State with the
expectation that the facility has achieved compliance status as alleged in
their plan of correction.
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