letter was developed to provide clarification regarding the expectations and approval process for facilities that intend to offer care for residents in a LTC facility.
The added language will make it clear that the initial notice is not the notice that triggers the imposition of remedies and that any such determination will be provided in a separate notice.
The purpose of this memorandum is to notify states and regional offices (ROs) of the publication on March 25, 2005 in the Federal Register (Vol. 70, No. 57, page 15229), of an interim final rule with comment period entitled "Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities; Amendment."
The Centers for Medicare & Medicaid Services has completed their work to produce new surveyor guidance for nursing home deficiency tag F501, Medical Director. The new guidance includes Interpretive Guidelines, an Investigative Protocol, and Severity guidance for deficiencies cited at F501.
The purpose of this memorandum is to affirm our expectation that when noncompliance with a federal requirement has been identified, the facility or provider will receive a deficiency associated with the noncompliance.
The purpose of this memorandum is to address the Centers for Medicare & Medicaid Services' (CMS) position regarding binding arbitration between nursing homes and prospective or current residents, in response to recent marketplace practices.
Effective January 1, 2003, nursing homes across America must publicly post the number of nursing staff they have on duty to care for patients on each daily shift. Licensed and unlicensed nursing staff includes: registered nurses, licensed practical nurses and nurse aides. CMS will publish a regulation later in this fiscal year defining this required format and content.
The purpose of this memorandum is to alert you to a requirement for skilled nursing facilities and nursing facilities.
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.
The purpose of this program memorandum is to provide information and guidance to regional offices, and state survey agency personnel regarding a new regulation that will remove the federal barrier requiring nursing home providers, home health agencies and hospitals to have individually signed physician's order for influenza and pneumococcal vaccines.
The purpose of this memorandum is to give the State Survey Agencies (SAs) advance notice of coming refinements to Nursing Home Compare and to notify them of CMS' expectations.
It has come to our attention that Medicare-certified, or dually-certified nursing homes may not be receiving hearings to challenge their loss of authority to conduct a nurse aide training and competency evaluation program (NATCEP) even when they have sought such hearings. We wish to clarify the requirements of the regulations that provide for such hearings to make sure that we are implementing them in a proper and consistent fashion.
This memorandum directs survey agencies to ensure that certified nursing homes are correctly completing the data fields on the form CMS-671.
This memorandum provides guidance to State Survey Agencies (SAs) regarding the informal dispute resolution (IDR) process.
The purpose of this memorandum is to clarify the Centers for Medicare & Medicaid Services' (CMS) policy regarding several Life Safety Code (LSC) issues dealing with the sprinklering of wardrobes/closets, the requirements for surfacing of exit discharge pathways, and the requirements for the sprinklering of canopies in nursing homes.
This memo serves the purpose of differentiating the need for trained nurse aid assistance in moving and transferring residents.
Clarify the regulations at 42 C.F.R. Section Section 483.13(c)(2) and (4). In particular, these sections address the facility's obligations to report allegations and the results of the investigation of these alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property.
Clarifies the phrases 'remove easily' and 'freedom of movement' as related to the physical restraints definition. Further clarifies the meaning 'medical symptom.'
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.
The purpose of this memorandum is to address issues of nursing homes requiring promissory notes or deposit fees as a condition of admission and the implications of deposit fees on surety bonds.
The purpose of this memorandum is to notify States and Regional Offices (ROs) of the upcoming dates for nursing homes to comply with requirements concerning emergency light and the replacement of roller latches originally published January 10, 2003, in the Federal Register (Vol. 68, No. 7, page 1374) as a final rule entitled "Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities."
This memorandum describes the steps CMS is taking to ensure that necessary safeguards are in place for residents of LTC facilities who receive dialysis.
The purpose of this memorandum is to notify you that we have made a set of technical corrections to several sections of Appendix PP of the SOM. Overall, the changes included adding new regulatory language, correcting errors (such as missing text), and moving certain regulatory language that had been added to 483.15 (Quality of Life) back to former locations.
The purpose of this memorandum is to clarify the Centers for Medicare and Medicaid Services'(CMS) policy regarding corridor width requirements and the installation of computer touch screens in health care facilities.
The purpose of this memorandum is to clarify the definition of the term "significant difference" as used in State Performance Standard #3 (certifications are fully documented, and fully consistent with applicable law, regulations and general instructions), the FOSS and Comparative Survey Access database, and Online Survey Certification And Reporting (OSCAR) system for LTC surveys.
The purpose of this memorandum is to clarify five commonly used terms in the LSC of the NPFA.
The Centers for Medicare & Medicaid Services (CMS) has a project underway to convene expert panels to assist in developing revisions to interpretive guidelines at several key Tags in the State Operations Manual (SOM), Appendix PP.
This document provides a comprehensive description of the design for the Nursing Home Compare Five-Star Rating System.
The purpose of this memorandum is to provide guidance to Regional Office (RO) and State Agency (SA) personnel regarding the use of electronic signatures by certified long-term care providers who have the capability to implement electronic signatures for their clinical records.
The intent of this clarification is to inform certified long-term care providers who have the capability to implement electronic signatures for their MDS documentation that they may do so whether or not the clinical record is entirely electronic.
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.
States should review their policies regarding the IDR process for Medicare/Medicaid nursing homes in order to determine whether they are consistent with Federal regulations and the State Operations Manual (SOM).
Attached to this memorandum is a 4-page brochure describing the QIS and the Centers for Medicare & Medicaid Services Demonstration. The document provides information about the features of the QIS and the 5-State Demonstration in Connecticut, Kansas, Ohio, California, and Louisiana.
The purpose of this memorandum is to emphasize the importance and expectation of SAs working with QIOs in promoting quality of care in nursing homes.
This letter clarifies that nursing homes are required to post survey results in a place readily accessible to residents, family members and legal representatives, and that the state or Secretary is required to make survey results available to the general public.
The purpose of this letter is to provide guidance regarding the impact of the HIPAA Privacy Rule on the nursing home requirements regarding the posting of survey results as stated in the Social Security Act (SSA).
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.
CMS directed state survey agencies (SAs) to conduct two standard surveys per year for each SFF instead of the one required by law. CMS also requested that states submit a monthly status report listing any surveys, revisits, or complaint investigations of SFF they had conducted in that month.
The purpose of this policy letter is to reiterate the role and function of surveyors during the survey process on the issue of consultation, technical assistance, and sharing best practice information.
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.
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.
Revised guidance for long-term care surveyors regarding Activities (Tags F248 and F249) will be effective June 1, 2006. 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.
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.
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.
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.
Revised guidance for long-term care surveyors regarding Quality Assurance and Assessment condenses Tags F520 and F521 into one tag - F520 - and will be effective 06/01/2006. 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.
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.
The purpose of this memorandum is to advise you of a set of changes that we have made to Appendix P of the SOM, Survey Protocol for Long Term Care Facilities, and to certain Exhibits.
New guidance for long-term care surveyors regarding the Psychosocial Outcome Severity Guide becomes effective June 1, 2006. 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.
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).
LSC surveys are required for initial and recertification of facilities subject to Survey and Certification inspections for Medicare/Medicaid certification.
The purpose of this memorandum is to inform you that CMS will be providing an updated set of LSC reference materials to CMS ROs and SAs that perform fire safety surveys for each state.
This letter is intended to clarify the process for conducting Task 5E, Medication Pass, of the Survey Procedures for Long Term Care Facilities.
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.
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.
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.
The purpose of this memorandum is to notify states and regional offices (ROs) of the publication on January 10, 2003, in the Federal Register (68 FR 1374), of a final rule entitled “Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities.”
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.
The purpose of this memorandum is to notify states and regional offices of changes in the HCFA-855 application and procedures. The new applications relevant for your use are the HCFA-855A and HCFA-855B. These replace the HCFA-855 and HCFA-855C applications dated January 1998.
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.
The Quality Net (QNet) is in the process of complying with the Centers for Medicare & Medicaid Services' (CMS') mandated 3-tiered architecture structure and the use of new QNet approved reporting software.
A CMS tool to compare Medicare- and Medicaid-certified nursing homes.
This memorandum asks all State Survey Agencies (SAs) to remind all Medicare and Medicaid participating nursing homes in the State of the Federal requirements related to screening potential employees and checking with all appropriate nurse aide registries. This memorandum also provides contact information for nurse aide registries in every State.
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).
A final rule published by the Centers for Medicare & Medicaid Services (CMS) on October 7, 2005 (70 FR 58834) requires Medicare & Medicaid participating nursing homes to provide residents with the opportunity to be immunized against influenza and pneumonia. An advance copy of the new surveyor guidance for immunization requirements will be published in late spring of 2006.
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.
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.
This memorandum clarifies survey and certification actions related to citations of past noncompliance.
This memorandum establishes an effective date for new surveyor guidance for incontinence and catheters of June 27, 2005, to match the ASPEN release date.
During the Alliance for Consistency conference and the January 2001 Association of Health Facility Survey Agencies Executive Board meeting, clarification was requested on the ten percent off-hour (staggered survey) requirement contained in Section 7200 of the State Operations Manual (SOM). Specifically, questions were raised regarding 1) acceptable starting times for off-hour surveys, 2) the definition of “holiday” and how surveys that begin on holidays should be reflected in OSCAR and 3) whether States must initiate off-hour surveys in each of the targeted time periods (i.e., early morning, evening and weekend). Clarification of HCFA's policy in these three areas follows.
A question was raised at February's “Alliance for Consistency” conference about whether paper reviews, i.e., paper revisits, are included in the revisit count under the May 3, 2001 revisit policy. This question generated some discussion and it was agreed that clarification would be forthcoming.
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.
The purpose of this memorandum is to clarify for State survey agencies and providers the regulatory differences concerning physician delegation of tasks in SNFs and NFs.
On September 22, 2000, we released a memo transmitting two enforcement policies, one concerning verification of facility compliance and the other pertaining to setting the effective dates for the mandatory 3- and 6-month remedies. The policy about facility compliance generated much discussion, and, after reconsideration of some of the issues raised, we have revised the guidance which is attached.
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.
The purpose of this memorandum is to inform you of the actions to be taken by the SA, CMS RO, and CMS CO in the event of a fire in a Medicare/Medicaid certified health care facility that results in serious injury or death.
The purpose of this memorandum is to inform you that the Centers for Medicare & Medicaid Services has developed several promising practices for the successful implementation of the Medicare Hospice Benefit for nursing home residents. The following practices were developed after consultation with the long-term care and hospice industry representatives and are part of our commitment to assure that nursing home residents who elect the hospice benefit receive the needed care and services from providers.
This memorandum provides information to support State Survey Agencies during the intake of complaint allegations about the care and services provided to nursing homes residents.
Besides the SA, other public entities receive information and/or perform investigations of nursing homes. These entities include the office of the coroner or medical examiner, quality improvement organizations, law enforcement, the ombudsman's office, and protection and advocacy.
Announces the release of the Study of Paid Feeding Assistant Programs report and Web site location.
This memorandum clarifies the Centers for Medicare & Medicaid Services' (CMS) policy with regard to preventing, citing and reporting abuse in nursing homes.
On October 1, 2001, the revised procedure for conducting Federal Oversight Support Surveys (FOSS) became effective. In support of the relationship between states and regions, we are standardizing the response format that state agencies may utilize should an expression of clarification or disagreement arise. Attached to this memorandum is the procedure for resolving disagreements resulting from a FOSS survey.
The purpose of this memorandum is to provide you with our answers to questions which we received from the NHPCO.
Revised Nursing Home Medical Director Tag and Accompanying Training Materials
The purpose of this letter is to remind state survey agencies (SAs) of their role in the Office for Civil Rights (OCR) clearance process
This memorandum provides information to support State Survey Agencies that choose to incorporate photographic documentation into their survey process.
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.
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).
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.
The Centers for Medicare & Medicaid Services (CMS) has had a project underway to convene expert panels to assist in developing revisions to interpretive guidelines at several key Tags in Appendix PP of the SOM.
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 purpose of this memorandum is to instruct surveyors on what to do when long-term care (LTC) facilities are acquiring and dispensing of foreign drugs for the purpose of consumption by residents.
This memorandum is to provide you with information on the imminent introduction of complaint data on the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare website.
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.
The purpose of this memorandum is to provide information regarding how states may use CMP funds collected from nursing homes that have been out of compliance with Federal requirements. It has come to our attention that guidance is needed to ensure that states use CMP funds in accordance with the law and in a consistent manner, while maintaining some flexibility in the use of those funds.
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.
The purpose of this memorandum is to identify the responsibilities of The Centers for Medicare & Medicaid Services (CMS) under the Social Security Act (the Act) and the regulations when a SNF or NF voluntarily terminates from the Medicare/Medicaid Programs.