Nursing Home Enforcement - Frequently Asked Questions 1. What role does CMS play in imposing enforcement actions Federal enforcement actions, referred to as remedies, are imposed by the CMS Regional Offices for the respective States in their jurisdiction. The State Operations Manual (SOM) describes how surveys are to be conducted and provides guidance on the survey and enforcement process. 2. What is an enforcement action An enforcement actionis the process of imposing one or more of the following remedies in accordance with 42 CFR §488.406: Termination of the provider agreement Temporary management Denial of payment for all Medicare and/or Medicaid individuals by CMS; Denial of payment for all new Medicare and/or Medicaid admissions Civil money penalties State monitoring Transfer of residents Transfer of residents with closure of facility Directed plan of correction Directed in-service training and Alternative or additional State remedies approved by CMS.