On November 24th, the Survey and Certification Group (S&C) at CMS issued two memos that further delay enforcement of provisions of the new requirements of participation but falls short of the complete delay that American Health Care Association and members had sought. These memos indicate that CMS is delaying some enforcement provisions of the Phase 2 requirements, but CMS will proceed with implementing the new survey process beginning tomorrow, November 28.
In S&C: 18-04-NH Temporary Enforcement Delays for Certain Phase 2 F-Tags and Changes to Nursing Home Compare, CMS states it is proceeding with implementing Phase 2 of the Requirements of Participation with the following changes:
- Temporary moratorium on imposing certain enforcement remedies for specific Phase 2 requirements: CMS will provide an 18-month moratorium on the use of certain enforcement remedies (CMP, DPNA and discretionary termination) for specific Phase 2 requirements (see below). However, CMS may use directed plans of correction or directed in-services for these specific Phase 2 requirements. This 18-month period will be used to educate facilities about specific new Phase 2 standards.
- Freeze Health Inspection Star Ratings: Following the implementation of the new survey process on November 28, 2017, CMS will hold constant the current health inspection star ratings on the Nursing Home Compare website for any surveys occurring between November 28, 2017 and November 27, 2018. There is no change to the staffing or quality measure component and the overall rating can still change based on your staffing and quality measure component.
- Availability of Survey Findings: The survey findings of facilities surveyed under the new survey process will be published on Nursing Home Compare, but will not be incorporated into calculations for the Five-Star Quality Rating System for 12 months. CMS will add indicators to Nursing Home Compare that summarize survey findings.
- Methodological Changes and Changes in Nursing Home Compare: In early 2018, Nursing Home Compare health inspection star ratings will be based on the two most recent cycles of findings for standard health inspection surveys and the two most recent years of complaint inspections.
Phase 2 Requirements Impacted by the Temporary Enforcement Moratorium
CMS has provided the following list of F-Tags included in the 18-month moratorium on the use of CMPs:
- F655 (Baseline Care Plan); §483.21(a)(1)-(a)(3)
- F740 (Behavioral Health Services); §483.40F741 (Sufficient/Competent Direct Care/Access Staff-Behavioral Health); §483.40(a)(1)-(a)(2)
- F758 (Psychotropic Medications) related to PRN Limitations §483.45(e)(3)-(e)(5)
- F838 (Facility Assessment); §483.70(e)
- F881 (Antibiotic Stewardship Program); §483.80(a)(3)
- F865 (QAPI Program and Plan) related to the development of the QAPI Plan;
- §483.75(a)(2) and,
- F926 (Smoking Policies). §483.90(i)(5)
Five-Star Rating System Changes
Five-Star Rating changes will only be frozen for any surveys or IDRs that are initiated after November 28, 2017. Any survey or IDR that was initiated before November 28, 2017 will continue to impact facility Five-Star Ratings. Survey results, including the number, type and severity of deficiencies, will continue to be posted on Nursing Home Compare. The memo also states that in early 2018, CMS intends to recalculate all Five-Star Ratings, excluding the third oldest survey from every rating. After that time, only the past two surveys will be included in the rating system.
CMS recommends that providers impacted by this freeze that are involved with ACOs or managed care provide a copy of this memo to the ACO or hospital.
New Survey Process
In S&C: 18-05-NH Preparation for Launch of New Long-Term Care Survey Process, CMS confirms they will begin the new survey process tomorrow, November 28, 2017. The memo provides guidance to state surveyors as they implement the new survey.
If you have any questions, please contact Helen Magliozzi, Director of Regulatory Affairs at 617-558-0202, ext. 228. Thank you.