The Centers for Medicare & Medicaid Services (CMS) has released revisions of its March 5, 2019 memo to state survey agencies to "Revisions to Appendix Q, Guidance on Immediate Jeopardy". CMS has added language to Appendix Q to give state survey agencies guidance on when they must report suspected illegal acts to law enforcement. The language added to Appendix Q now specifies that when a deficiency is identified, if illegal activity is connected to the deficiency, the state surveyor and state survey agency have an obligation to report the illegal activity to law enforcement. Specifically, CMS added the following: "When the identified noncompliance is determined to have been caused by, or has led to a criminal act, reporting must be made to local law enforcement. If the entity refuses to report, or the surveyor cannot verify that a report was made to local law enforcement, the surveyor must consult with his/her supervisor immediately, and the State Agency must report the potential criminal incident to law enforcement immediately."