On June 29, 2022 CMS released QSO-22-19-NH Revised Long-Term Care Surveyor Guidance which includes revisions to surveyor guidance on Phases 2 & 3, arbitration agreement requirements, investigating complaints and facility reported incidents and the psychosocial outcome severity guide.
CMS also released an advance copy of the Appendix PP, SOM Chapter 5, and the Psychosocial Outcome Severity Guide.
Summary of Significant Changes
- Abuse and Neglect - Clarifies compliance, abuse reporting, including sample reporting templates, and provides examples of abuse that, because of the action itself, would be assigned to certain severity levels.
- Admission, Transfer, and Discharge - Clarifies requirements related to facility-initiated discharges.
- Mental Health/Substance Use Disorder (SUD) - Addresses rights and behavioral health services for individuals with mental health needs and SUDs.
- Nurse Staffing (Payroll-Based Journal) - Uses payroll-based staffing data to trigger deeper investigations of sufficient staffing and added examples of noncompliance.
- Resident Rights - Imports guidance related to visitation from memos issued related to COVID-19, and makes changes for additional clarity and technical corrections.
- Potential Inaccurate Diagnosis and/or Assessment - Addresses situations where practitioners or facilities may have inaccurately diagnosed/coded a resident with schizophrenia in the resident assessment instrument.
- Pharmacy - Addresses unnecessary use of non-psychotropic drugs in addition to antipsychotics, and gradual dose reduction.
- Infection Control - Requires facilities have a part-time Infection Preventionist. While the requirement is to have at least a part-time IP, the IP must meet the needs of the facility. The IP must physically work onsite and cannot be an off-site consultant or work at a separate location. IP specialized Training is required and available.
- Arbitration - Clarifies existing requirements for compliance when arbitration agreements are used by nursing homes to settle disputes.
- Psychosocial Outcome Severity Guide - Clarifies the application of the “reasonable person concept” and severity levels for deficiencies. https://www.cms.gov/files/document/psychosocial-outcome-severity-guide.pdf.
- State Operations Manual - Chapter 5- Clarifies timeliness of state investigations, and communication to complainants to improve consistency across states.
Phase 3 requirements such as Trauma Informed Care, Compliance and Ethics, and Quality Assurance Performance Improvement (QAPI) as well as the clarifications of Quality of Life and Quality of Care, Food and Nutrition Services, and Physical Environment are also included in this updated guidance. QSO-22-19-NH includes recommendations related to resident room capacity. There are no new regulations related to resident room capacity. However, CMS is highlighting the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and a homelike environment.
Training Resources
CMS has publicly posted training to explain the updates and changes of the regulations and interpretive guidance for surveyors and nursing home stakeholders at the Quality, Safety, and Education Portal. This training is now available. In addition, Mass Senior Care will be offering a training session focusing on the Requirements of Participation in the near future.
Surveyors will begin using this guidance to identify non-compliance on October 24, 2022.