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    CMS/State Directed Remedies  






Major Changes in Nursing Home Inspections!

Should your facility be cited during the ‘New’ Survey in Phase 2, for 18 months there will be only three CMS/State Directed remedies imposed:

1. Directed In-Service Training
2. Directed Plan of Correction
3. Directed Placement of Temporary Manager

These remedies are to be provided by organizations that do not
have financial or operational ties to the cited facility.

In place of:

  • Civil money penalties (CMP)
  • Discretionary denials of payment on new admissions (DPNA)
  • Discretionary termination

Exceptions:  DPNA may be issued if facility has not achieved compliance within 3 months of the finding; termination after 23 days for immediate jeopardy; and termination after 6 months for non-immediate jeopardy non-compliance.

If your facility is cited during a survey and direct to implement one or more of the CMS/State Directed Remedies, you will only have 10 days to complete the remedy.

Tobin & Associates, Inc. can help with these remedies and if you would like, we can help you identify if the citation is accurate or disputable.  We can also assess whether or not the cited issue is isolated or a result of a system failure.

Phase 2 of the major changes in Nursing Home Regulatory Interpretive Guidelines went into effect November 28, 2017. Even though the nursing home industry lobbied hard for the delay of Phase 2, the Consumer Voice and other advocacy organizations strongly opposed postponing Phase 2 implementation and won.

Phase 2 requirements include for example:

  • Suspicion of a crime to law enforcement
  • Appropriate treatment and services for residents with dementia and behavioral issues
  • Established facility assessment
  • Established baseline care plan
  • An antibiotic stewardship program
  • Policies regarding loss and replacement of dentures
  • Polices on smoking
  • PRN limitations on psychotropic medications
  • QAPI program and plans
  • Etc.

In the past the survey protocol was laid out in the Appendix P of the State Operations Manual, however, now CMS has replace Appendix P with a Long-Term Care Survey Process (LTCSP) procedure guide which will be what surveyors will follow when conducting a standard survey.

The protocol will be different under the new survey process; therefore, CMS decided that consumers and others would not be comparing ‘apples to apples’ facility survey reports under the old system to the new process.  As a result, at this current time, CMS will be holding constant, or ‘freezing’ the health inspection five-star rating for health inspection surveys and complaint investigations conducted on or after November 28, 2017.  Consumer Voice will be providing more information regarding the changes to Nursing Home Compare and the five-star rating system.

There is an 18 month moratorium on enforcement of the following regulations:

F655 – Baseline Care Plan
F740 – Behavioral Health Services
F741 – Sufficient/Competent Direct Care/Access Staff-Behavioral Health
F758 – Psychotropic Medications
F838 – Facility Assessment
F881 – Antibiotic Stewardship Program
F865 – QAPI Program and Plans
F926 – Smoking Policies

The above information was gathered through:

To read memo issued by CMS regarding the moratorium, go to http://theconsumervoice.org/uploads/files/issues/Survey-and-Cert-Letter-18-04.pdf

To learn more about the new process, go to:
https://www.cms.gov/Medicare/Provider-Enrollment-and-Cerification/GuidanceforLawsAndRegulations/Nursing-Homes.html (then click on ‘New Long-term Care Survey Process – slide deck and speaker notes)


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