CMS Releases Survey Interpretive Guidance
In September 2016, the Centers for Medicare & Medicaid Services (CMS) released revised Requirements for Participation under the Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities Rule (RoPs). As a result of the revised requirements, CMS has released revised Interpretive Guidance that becomes effective Nov. 28, 2017. The revised Interpretive Guidance document is almost 700 pages.
CMS has noted that many standards have remained unchanged since the early 1990s. For these areas, they reviewed the existing Interpretive Guidelines and updated where necessary to ensure that the standards and examples were clear. CMS has also added sections titled “Key Elements of Noncompliance” in some areas of the Interpretive Guidance. This is intended to guide surveyors and nursing facilities about the key behaviors and practices identified in the regulation.
Over the next few months, CMS plans to provide a number of training opportunities to promote a greater understanding of the new requirements and Interpretive Guidance. On Tues., July 25th, the Medicare Learning Network (MLN) will host a call on the Interpretive Guidance and Survey Process. Other training opportunities will be made available on the Surveyor Training Website in the coming months.
CMS has also provided additional material on the new survey process, a crosswalk for the F-Tags, a listing of new F-Tags, and other informative documents.
CMS will be providing limited enforcement remedies for certain Phase 2 provisions. They 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, and/or termination should a facility be found to be out of compliance with these new requirements beginning in November 2017. Instead, they 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 notes, however, that the one-year period is not a change in the required implementation date for Phase 2 provisions.
With regard to Nursing Home Compare, CMS will be holding constant the Nursing Home Compare health inspection rating for one year for any surveys conducted after Nov. 28, 2017. To address the concern that serious quality concerns will not be known, they will separately flag those nursing facilities to ensure public transparency. CMS will provide more detailed methodology information at a later date. While the nursing home inspection rating will not change as a result of a poor survey, it will also not change as a result of a good survey for one year for surveys conducted after Nov. 28, 2017.
Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832