Two New QSOs from CMS: Revisions to the Special Focus Facility (SFF) Program and Revisions to State Operations Manual (SOM) Chapters 5 & 7
At the end of last week, CMS issued two memos impacting skilled nursing facilities, with revisions to the Special Focus Facility (SFF) program and revisions to the State Operations Manual (SOM).
Here are overviews of the memos:
QSO-23-01-NH REVISED – Revisions to the Special Focus Facility (SFF) Program
Under QSO-23-01-NH REVISED, CMS is changing the focus area for selection of Special Focus Facilities to emphasize the prevalence of falls among the resident population. IN addition, survey predictability will be reduced for SFF program participants.
As a result of the Office of Inspector General (OIG) Report released last September highlighting a lack of reporting on falls, the changes to the SFF Program will prioritize facilities with a prevalence of falls, rather than focusing on staffing for selecting a SFF.
In addition, regarding enforcement, previously the state agency conducted standard health surveys at least once every six months. Under the revisions, the state agency will conduct standard health surveys no less than twice annually or complaint surveys are at least once every six months. Life Safety Code and Emergency Preparedness surveys will also occur at least annually, or more as determined by the State or CMS.
QSO-26-03-NH – Revisions to the State Operations Manual (SOM) Chapters 5 and 7
Under QSO-26-03-NH, CMS makes changes to Chapters 5 and 7 of the SOM.
The revisions to Chapter 5 clarifies that off-site investigations must be approved by CMS in advance, and provide more examples of Immediate Jeopardy Priority Definitions for nursing homes, to include “all intakes alleging abuse of a resident/patient/client that involve serious injury, harm, impairment, or death of a resident/patient/client or likelihood for such, and it is uncertain that they are adequately protected. For nursing homes, all intakes where a resident was discharged to an unsafe setting, or in a manner that place the resident at risk for serious harm (e.g. the resident still has medical needs but they cannot be supported in the setting they were discharged to).
The revisions to Chapter 7 make numerous changes relating to survey team composition, survey procedures, plans of correction, verifying corrections, survey revisit and offsite revisit paper review, off-site survey, enforcement, nurse staffing waivers, disposition of civil money penalties, federal civil penalties inflation reduction act, informal dispute resolution, and independent informal dispute resolution. Additionally the update includes guidance previously in Appendix P, adding it to Chapter 7, and technical changes to ensure accurate references.
The memo updates the following definitions in Chapter 7 of the SOM: Abuse, Facility, Immediate Family, Instance or Instances of noncompliance, Neglect, New Admission, Noncompliance cycle, Nurse aide, Partial extended survey, Plan of correction, Resident Representative or Representative, and Substandard Quality of Care.
Please see the full QSO-26-03 NH for details, all new language is in red, so it is easy to pick out.
