On November 20, 2023, CMS released Admin Memo: 24-05-NH to provide guidance to surveyors on areas of focus for Federal Monitoring Surveys (FMS). As part of CMS’ oversight of State Survey Agencies (SSA) and to validate the findings of the SSA surveys, federal monitoring surveys are required to be completed in at least 5% of skilled nursing facilities in each state (but no less than five total skilled nursing facilities in the state).
For Fiscal Year 2024 and Fiscal Year 2025, CMS identified three long-term care (LTC) Health National Concern Areas. The National Concern Areas were identified based on internal CMS data sources, OIG
recommendations, and the White House Initiative to Improve Care in Nursing Homes. The table below includes the associated F-Tags, Regulatory Groupings, and Critical Element Pathways for these concern areas.
|
# |
Focus Concern |
Regulatory Grouping(s) |
F-Tags |
Critical Element Pathways |
|
1st |
Nurse Staffing |
Administration (§483.70) |
F851: Payroll Based Journal |
Sufficient and Competent Nurse Staffing |
|
Nursing Services (§483.35) |
F725: Sufficient Nurse Staffing F727: RN 8 Hrs/7 days/WK, Full Time DON |
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|
2nd |
Unnecessary Psychotropic Medication |
Resident Assessments (§483.20) |
F641: Accuracy of Assessments |
Unnecessary Medications
Psychotropic Medications
Medication Regimen Review |
|
Comprehensive Resident Centered Care Plan (§483.21) |
F658: Services Provided Meet Professional Standards |
|||
|
Pharmacy Services (§483.45) |
F758: Free from Unnecessary Psychotropic Meds/PRN Use |
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|
3rd |
Facility- Initiated Discharge |
Admission, Transfer, and Discharge (§483.15) |
F622 Transfer and DischargeRequirements F624: Preparation for Safe/ Orderly Transfer/ Discharge F626: Permitting Residents to Returnto Facility |
Discharge |
Resources to Improve Quality of Care:
The critical element pathways identified in the table above may be found at CMS Nursing Home Website under Survey Resources. CMS has developed new Quality in Focus interactive videos series. The series of 10–15-minute videos are tailored to provider types and aim to reduce the deficiencies most commonly cited during the CMS survey process, like infection control and accident prevention.