The Centers for Medicare and Medicaid Services released a new Survey and Certification letter (S&C: 17-36-NH) detailing revisions to the State Operations Manual Appendix PP for Phase 2, F-Tag revisions and related issues. The revisions take effect Nov. 28.
The letter covers the following areas:
Revised Interpretive Guidance - In September, CMS released revised Requirements for Participation under the Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities rule. As a result of those changes, CMS has released revised Interpretive Guidance, effective Nov. 28. For areas that were not changed, CMS reviewed the existing guidelines and updated where necessary. CMS also added a section in some areas to the Interpretive Guidance titled “Key Elements of Noncompliance” to guide surveyors and nursing facilities about key behaviors and practices.
Revised F Tags - The revisions to the regulations caused many of the prior regulatory citations to be re-designated, and CMS was required to re-number the F-Tags to identify each regulatory part. CMS has provided a crosswalk for the F-Tags to assist surveyors and providers with understanding the changes.
Notification about Training Resources - CMS is providing several training resources:
- A Medicare Learning Network call on July 25 from 1:30 to 3 p.m. to discuss the Interpretive Guidance and Survey Process. Questions can be submitted in advance. Information about the call can be found at the CMS website when it is posted in the coming weeks.
- A CMS slide deck outlining the new survey process.
- The Integrated Surveyor Training Website, which will offer training videos by CMS staff to review highlights of 11 key topics for the Interpretive Guidance; self-paced, online training describing the survey process changes; and provider-specific training that will focus on those elements needed for the LTC survey process.
Enforcement Considerations – To address concerns related to the scope and timing of the changes, CMS will provide limited enforcement remedies for certain Phase 2 provisions. CMS will provide a one-year restriction of enforcement remedies for specific Phase 2 requirements. The listing of specific Phase 2 requirements associated with enforcement delays will be shared at a later date. CMS will not utilize civil money penalties, denial of payment or termination should a facility be found to be out of compliance with these new requirements beginning in November. Rather, CMS will use the year-long period to educate facilities about certain new Phase 2 quality standards by requiring a directed plan of correction or additional directed in-service training. Enforcement for other existing standards (including Phase 1 requirements) will follow the standard process. CMS warns, however, that the one-year period is not a change in the required implementation date for Phase 2 provisions.
Nursing Home Compare Considerations - CMS will hold constant the Nursing Home Compare health inspection rating for one year for any surveys conducted after Nov. 28. To address the concern that serious quality concerns will not be known, CMS will separately flag those nursing facilities to ensure public transparency. CMS will provide more detailed methodology information at a later date.