|  | | | CMS changes in regulations and F-tags through September 2007. New in this edition: Accidents & Supervision, Paid Feeding Assistants, and changes in Appendix P. | |
| | | | The 9th Scope of Work for QIOs directs each QIO to provide technical assistance to a SFF nursing home in each State in each of the three years of the contract. If you have suggestions with regard to which SFFs you believe are most in need and most appropriate for technical assistance, please communicate those ideas to your QIO as soon as possible (preferably by August 22, 2008).
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| | | | Revised guidance for long-term care surveyors regarding Nutrition and Sanitary Conditions (Tags F325 and F371) will be effective September 1, 2008. An advance copy of this guidance and training slides are attached. A comprehensive training guide has been sent to State and regional office training coordinators under separate cover to assure that all surveyors who survey nursing homes are trained in the revised guidance by the implementation date. | |
| | | | For your information, we are providing an updated, 2008 version of the brochure that provides a brief description of the QIS and an overview of the QIS training process. | |
| | | | Attached are Federal minimum standards for training surveyors and trainers in the QIS. These standards are intended to assure effective and consistent QIS implementation for the training of State and Federal surveyors and their trainers in the Federal QIS process. | |
| | | | CMS has been asked to clarify the use of the Interpretive Guidance to Surveyors for Long Term Care Facilities in reviewing for compliance with the regulatory requirements for nursing homes. Surveyors must cite all deficiencies based on a violation of statutory and/or regulatory requirements.
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| | | | When a nursing home (facility) receives food services from an off-site location, the surveyor must assess whether the facility is compliant with 42 C.F.R. 483.35(i) which states: a facility must procure food from sources approved or considered satisfactory by Federal, State, or local authorities.
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| | | | CMS, together with States, seeks to maintain effective quality assurance in the Medicare program at the same time that 1) Many new providers are applying to participate in Medicare for the first time; and 2) Resources are highly constrained since the President's proposed budget for Survey and Certification (S and C) has not been fully funded for the past three consecutive years. Appendix A therefore contains revised survey priorities and procedures to ensure that we obtain greater value from each survey dollar expended, and that CMS' priority structure for survey and certification activities are followed faithfully. | |
| | | | This memo amends SC Memorandum 05-13 to improve the national Special Focus Facility (SFF) initiative. The SFF is designed to increase the probability that nursing homes which have consistently exhibited serious quality problems will significantly improve their quality of care and safety of residents in the near future. | |
| | | | CMS is clarifying the current nursing facility survey process related to the selection of sampled residents with serious mental illness and mental retardation, to ensure that surveyors review required PASRR documentation. PASRR requirements are found in the State Operations Manual (SOM), Appendix P Survey Protocol for Long-Term Care Facilities and Appendix PP Interpretive Guidance for Long-Term Care Facilities. | |
| | | | A nursing home's noncompliance with the administration of nutritional and dietary supplements should not be included in the calculation of the facility's medication error rate at F332 or as a significant medication error at F333. We expect that the nursing home staff, along with the prescriber and consulting pharmacist, are aware of, review for, and document any potential adverse consequences between medications, nutritional supplements, and dietary supplements that a resident is receiving.
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| | | | Announces the release of the Study of Paid Feeding Assistant Programs report and Web site location. | |
| | | | New guidance for long-term care surveyors regarding the requirements for Paid Feeding Assistants will be published August 17, 2007. An advance copy of this guidance is attached. | |
| | | | This memorandum modifies S&C-05-38 "";Clarification of Life Safety Code issues in Nursing Homes""; in regards to sprinklers in canopies and overhangs. The LSC requires that most canopies and large overhangs be sprinklered (in facilities where the regulations require sprinklers). The Fire Safety Evaluation System may be used when evaluating the level of safety provided for a Health Care occupancy where a canopy or overhang is required to be sprinklered. | |
| | | | Revised guidance for long-term care surveyors regarding 42 C.F.R. 483.25(h)(1)and(2): Accidents and Supervision (Tag F323) will be effective August 6, 2007. An advance copy of this guidance and training materials are attached. This training packet is to be utilized in assuring that all surveyors who survey nursing homes are trained in the revised guidance by the implementation date.
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| | | | Clarifies the phrases 'remove easily' and 'freedom of movement' as related to the physical restraints definition. Further clarifies the meaning 'medical symptom.' | |
| | | | In a smoke compartment that is not fully sprinklered, a gap between the face of a corridor door and the door stop should not exceed 1/4-inch, provided that the door latch mechanism is functioning. In a smoke compartment that is fully sprinklered, a gap between the face of a corridor door and the door stop should not exceed 1/2-inch, provided that the door latch mechanism is functioning. | |
| | | | 1) Up to 300 cubic feet of nonflammable medical gas may be accessible as operational supply rather than storage, when properly secured. 2) An individual container of medical gas placed in a patient room for "";as needed""; (but regular) individual use is not required to be stored in an enclosure, when properly secured. | |
| | | | This memorandum provides the State Survey Agencies and CMS regional offices with: 1. Responses we have made to inquiries concerning compliance with the long-term care health and life safety code requirements in nursing homes that are changing their cultures and adopting new practices; 2. Summarizes questions and answers from a June, 2006 CMS Pic-Tel conference with leaders of the Green House Project (Attachment A); and 3. Provides information about an upcoming series of 4 CMS culture change satellite webcasts (Attachment B). | |
| | | | The FSES may be used when evaluating the level of safety provided for a Health Care occupancy that does not conform with the provisions of Section 7.7 "";Discharge from Exits""; NFPA, 2000 edition, including the use of unpaved exits under certain circumstances. See (NFPA 101A, Chapter 4, 2001 edition).
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| | | | This letter highlights the final rule concerning fire safety requirements for Hospitals, Ambulatory Surgical Centers, Nursing Homes, Religious Non-Medical Health Care Institutions, Programs of All-Inclusive Care for the Elderly (PACE) Facilities, Critical Access Hospitals, and Intermediate Care Facilities for the Mentally Retarded. | |
| | | | This memorandum provides information to support State Survey Agencies that choose to incorporate photographic documentation into their survey process. | |
| | | | Updates made 4/4/07 - Announces revised guidance for long-term care surveyors regarding Unnecessary Drugs, Pharmacy Services, Drug Regimen Review, and Labeling and Storage of Drugs and Biologicals will be effective December 18, 2006. ASPEN System changes in preparation for these revisions will be effective at the same time. | |
| | | | New guidance for long-term care surveyors regarding the provision of Influenza and Pneumococcal Immunizations becomes effective October 1, 2006. An advance copy of this guidance and training materials are attached. This training packet is to be utilized in assuring that all surveyors who survey nursing homes are trained in the new guidance by the implementation date. | |
| | | | 1) CMS delayed the June 1, 2006 implementation of the Psychosocial Outcome Severity Guide. 2) The psychosocial Outcome Severity Guide is implemented and effective as of June 8, 2006. 3) There were no changes to the Psychosocial Outcome Severity Guide from the advance copy version released on March 10, 2006 in memorandum S&C-06-10.
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| | | | 1) New Tag F356 has been developed for use in citing noncompliance regarding posting of nurse staffing information in lieu of Tag F492. 2)Tag F356 is effective immediately upon its availability after the ASPEN release in June. 3)Tag F492 remains for other issues involving compliance with Federal, State, and local laws; however, previous direction (S&C-03-11) to cite deficiencies in posting at Tag F492 is rescinded.
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| | | | 1) Clarifies what an acceptable amount of incidental air movement is in assessing whether a corridor is a plenum. 2) Adresses waiver criteria for facilities where a corridor is being used as a plenum in facility ventilation systems. | |
| | | | This memorandum clarifies residents' rights regarding choice of a prescription drug plan and pharmacy provider, the nursing homes' responsibility to provide drugs to residents, and State Survey Agencies' responsibilities with respect to the new Medicare prescription drug benefit and nursing homes: Residents have the right to make informed decision/choices about their care as described in sections 1802, 1851 and 1860 of the Social Security Act and 42 C.F.R. Part 483; Residents are guaranteed the right to choose a Part D plan, but do not have unbridled freedom to choose a pharmacy; and we expect nursing homes to work with their current pharmacies to assure that they recognize the Part D plans chosen by that facility's Medicare beneficiaries, or, in the alternative, to add additional pharmacies to achieve that objective. Or, at its option, the facility could contract exclusively with another pharmacy that contracts more broadly with Part D plans. | |
| | | | The purpose of this memorandum is to advise you of revisions we are making to Appendix P of the SOM, Survey Protocol for Long Term Care Facilities. The revisions include adding the Psychosocial Outcome Severity Guide to Part IV Deficiency Determinations, adding Determining Citations of Past Noncompliance at the Time of the Current Survey guide to Task 5, Information Gathering and to Task 6, Information Analysis for Deficiency Determination, and the revision of Tasks 2, 5F, and II.B.3. Also included in the revisions are corrections.
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| | | | This memorandum summarizes changes reflected in the revised and reformatted Chapter 5 of the SOM, published on March 17, 2006. Chapter 5 now covers basic complaint procedures for all providers and suppliers and includes pages numbers.
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