What happens after a nursing home is cited
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This guide follows one citation through the CMS record, in seven steps. For each step, it shows where the page of a home has the data. The guide describes the CMS record and is not legal advice.
1. The citation goes into the record
CMS adds the citation to its health deficiencies file with the F-tag, the scope and severity letter and the survey date. The page of the home lists it under "Health citations".
CMS adds inspection data when the State Survey Agency sends the full results. The time for this is different in each state, so a new citation can appear some time after the inspection.
2. The home corrects the deficiency
The "Corrected" column shows the date of the correction. If the column has no date, it shows the CMS status of the correction.
For a citation at J, K or L with the status "Past Non-Compliance", CMS gives the points of the letter G.
3. Surveyors come back
Surveyors can come back to check the correction. CMS calls such an inspection a revisit. A first revisit adds no points to the health inspection score. More revisits add points:
| Revisit | Points |
|---|---|
| First | No points |
| Second | 50% of the health inspection score |
| Third | 70% of the health inspection score |
| Fourth | 85% of the health inspection score |
4. The home can dispute the citation
A home can dispute a citation in an Informal Dispute Resolution (IDR) or an Independent Informal Dispute Resolution (IIDR). CMS shows the citation during the dispute, and this site marks it.
CMS does not count the citation in the health inspection score until the dispute ends. The result of a dispute can change the scope and severity letter.
5. CMS can give a penalty
The CMS penalties file has two types of penalty:
- Fine. An amount in dollars.
- Payment denial. A period, in days, in which Medicare or Medicaid does not pay for new admissions.
The date of a penalty in the file is the date of the inspection that caused it. The file holds the penalties of three years. The page of the home lists them under "Penalties".
6. The star rating can change
Each citation adds points to the health inspection score. The health inspection rating can change when CMS has the results of a new inspection, a revisit or a dispute.
A citation for abuse can give the home the CMS abuse icon. With the icon, the health inspection rating is 2 stars at most. The glossary quotes the CMS criteria.
The block "Since the last CMS update" on the page of a home shows a rating that changed. The guide What the CMS star ratings measure has the method.
7. The Special Focus Facility program
CMS gives each home points for the citations of its last three standard surveys and of three years of complaint investigations. In each state, the homes with the most points are candidates for the Special Focus Facility program.
The State Survey Agency selects homes for the program from the candidates. It inspects a home in the program every six months.
A home leaves the program in one of two ways:
- It has two standard surveys in sequence, each with 12 or fewer citations and no citation above the letter E.
- CMS ends its participation in Medicare or Medicaid.
The page of a home shows the Special Focus status under "CMS flags".