Nursing home appealed after it failed a survey and CMS threatened to terminate its provider agreement. After immediate jeopardy items were corrected, the sanction was downgraded to denial of payment for new admissions and withdrawal of approval for nurse aide training program. The denial of payment resulted in a loss of $43,600. The nursing home appealed. The violations related to F-Tags 272, 279, 323 and 333. The primary argument reviewed here is that the survey materials were illegal because they constantly changed. The argument was rejected, noting that survey protocols are procedural in nature and are not subject to rule making notice requirements.