Johns Hopkins All Children’s Hospital announced Tuesday that it has not yet corrected key problems identified by regulators early this year and said it has entered a binding agreement with the federal government requiring it to take special steps to avoid being cut off from public funding.

This is the second time the hospital has needed an extension from regulators since January, when inspectors from the Centers for Medicare and Medicaid Services wrote a scathing report describing widespread violations of federal hospital safety rules.

[ Read the findings from the January inspection: New federal report details widespread problems at All Children’s ]

[ Read the March story: Federal inspectors find unresolved problems at All Children’s ]

The hospital also said that the state hospital regulator, the Agency for Health Care Administration, found specific problems in the hospital’s infection control unit. All Children’s will need to develop a plan to fix them by “early May.”

“We take these determinations very seriously, and we are dedicated to continuing to work closely with our regulators as we redouble our efforts around our culture of patient safety at Johns Hopkins All Children’s Hospital,” a hospital spokeswoman said in a statement.

The institution has been under scrutiny since a November Tampa Bay Times investigation revealed serious problems in its heart surgery unit that included the mortality rate tripling in two years.

[ Read the investigation: Johns Hopkins promised to elevate All Children’s Heart Institute. Then patients started to die at an alarming rate. ]

The agreement with the federal government is a “dramatic” step, designed to help hospitals at risk of losing public funding, said Suzanne Gellner, a healthcare quality and compliance consultant based in Richmond, Va.

“You have a choice. You can either relinquish your CMS status, or you can accept the agreement,” Gellner said.

Losing its Centers for Medicare and Medicaid Services status — which would cut off public funding — would have devastated the hospital. More than 60 percent of All Children’s patients were covered by public health insurance programs in 2017, according to a Times analysis of state data.

The contract — called a Systems Improvement Agreement — calls for All Children’s to hire an external consultant for 12 months to oversee the hospital’s improvement, with the federal government’s approval. That is a common feature of such agreements.

Gellner, who has been hired as the consultant in four of these cases by other facilities, described the process as “a valuable endeavor and an expensive endeavor” for the hospital. The consultant is generally paid by the hospital but is allowed to provide feedback directly to the federal agency under the agreement. Regulators will continuously evaluate the hospital’s progress.

“It’s going to require work of all levels in the hospital,” Gellner said. “It’s difficult, but it can be culture changing.”

The yearlong process would target problems that the state and federal governments found earlier this year.

In January, inspectors found widespread problems relating to the hospital’s management structure, quality assurance and infection control. It was placed in a rare status called immediate jeopardy, which means the hospital placed patients in imminent risk of harm.

In a February followup inspection, inspectors removed the immediate jeopardy status, but said the hospital was still out of compliance. The inspectors gave the hospital a deadline of mid-April to fix the remaining issues.

Tuesday’s announcement suggests the hospital failed to meet the April deadline for fixing some of the problems.

In an internal letter to staff, Johns Hopkins Health System President Kevin Sowers and All Children’s interim president Thomas Kmetz wrote: “We anticipate this will be a lengthy process and there will be multiple resurveys and other points of engagement with our regulators, but we are confident we will get through this chapter and be a stronger organization for it.”

[ Click here to read all of the Times’ coverage of All Children‘s Heart Institute ]