On June 29, 2022, CMS issued QSO-22-19-NH, which outlines new and revised guidance to surveyors and to providers related to implementation of the Requirements of Participation, including new enforcement policies.

Note: CMS announced that these changes will become effective as of October 24, 2022.

AHCA has developed a detailed summary of significant changes for each impacted area to assist with review and identification of potential action for facilities to consider related to the guidance. Please note the summary requires a member login to access.

WHCA/WiCAL has created the below overview of items included in the memo:

CMS has issued revised Phase II guidance, including:

• Increased oversight in abuse and neglect, via revisions to Appendix PP. CMS also issued examples of properly-filed FRIs in Ch 5 of the SOM, as well as a sample form for FRIs.
• Increased oversight related to admissions, transfers, and discharges, largely related to a facility not allowing a resident to return to the nursing home following an emergency hospital stay. If the facility initiates a discharge while the resident is at the hospital, the facility must have evidence that the resident’s status at the time the resident seeks to return to the facility (not at the time the resident was transferred for acute care) meets one of the discharge criteria in the CFR.

The memo also includes information on additional oversight related to providing care for residents with mental health and/or substance use disorders.

Through this document, CMS also incorporates PBJ staffing data for providers to review potential staffing shortages.

The memo also announced CMS will incorporate visitation policy from recent COVID-19 guidance into Appendix PP to ensure visitation can occur while also preventing/reducing the spread of communicable diseases like COVID-19.

New Phase III Implementation Guidance was included as well:

• CMS will be implementing the Infection Preventionist requirement. Nursing providers will be required to have a part-time Infection Preventionist on staff. In 2019, CMS originally announced that each facility would need a full-time Infection Preventionist, but scaled back that requirement to part-time. Note: WHCA/WiCAL is seeking additional clarification on the details of this part-time position, including who qualifies as an Infection Preventionist, and also what is sufficient to be considered part-time.
• The memo also provides notice of new language in the SOM related to allowable arbitration agreements. The main takeaway is that CMS prohibits facilities from requiring residents to sign binding arbitration agreements as a condition of admission or as a condition of continued care at a nursing facility. Facilities should clearly articulate that arbitration agreements are voluntary.

The memo also includes resident room recommendations:

• • This document encourages providers to make changes to the physical environment to have a max of 2 residents per room.
    • The justification CMS includes in the memo is to reduce room crowding and primarily to prevent the spread of communicable diseases like COVID-19.
  • In the memo, CMS really encourages a move toward single occupancy rooms, to allow for more privacy, a more homelike environment, and an improved physical environment for Infection Prevention and Control.

The memo also issues a revised Psychosocial Outcome Severity Guide.

All resources linked above include:

• QSO-22-19-NH (PDF)
• Appendix PP Guidance to Surveyor for Long Term Care Facilities (PDF)
• SOM Chapter 5 – Complaint Procedures (PDF)
• SOM Exhibit 23 – ACTS Required Field (PDF)
• SOM Exhibit 358- Sample Form for Facility Reported Incidents (PDF)
• SOM Exhibit 359- Follow-up Investigation Report (PDF)
• Psychosocial Outcome Severity Guide (PDF)

Once again, surveyors will begin using this guidance to identify noncompliance on October 24, 2022.