The Centers for Medicare & Medicaid Services (CMS) has issued additional updates to the State Operations Manual Appendix Q, including guidance to surveyors on citing immediate jeopardy.  

This time around, changes include the addition of one small, very significant paragraph: Surveyors are reminded that criminal acts must be reported to local law enforcement. Related to noncompliance and noncompliance cited at the level of immediate jeopardy, surveyors are advised that if the entity refuses to report or if the surveyor cannot verify that a report was made, the surveyor must consult with his/her supervisor and must report potential criminal incident to local law enforcement immediately.

An updated Appendix Q is included in the memo.