News Digest: PBJ Takes on a Bigger Role for State Survey Agencies
CMS issued a QSO memorandum that increased the role of payroll-based journal data in survey and increased the potential survey penalties for providers not fulfilling staffing requirements specified in the PBJ policies.
Effective October 24, 2022, CMS using PBJ staffing data to direct surveyors to investigate potential noncompliance with CMS’ nurse staffing requirements, including:
- insufficient staffing
- lack of a registered nurse for eight hours each day, or
- lack of licensed nursing for 24 hours a day.
CMS Issues Significant Updates to Improve the Safety and Quality Care for Long-Term Care Residents
Today, as part of the Biden-Harris Administration’s initiative to promote the safety and quality of nursing home care across the country, the Centers for Medicare & Medicaid Services (CMS) issued updates to guidance on minimum health and safety standards that Long-Term Care (LTC) facilities (often called “nursing homes”) must meet to participate in Medicare and Medicaid.
CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect residents of LTC facilities. The surveyors who use these resources to perform both routine and complaint-based inspections of nursing homes are responsible for determining whether facilities are complying with CMS’ requirements.
“CMS Issues Significant Updates to Improve the Safety and Quality Care for Long-Term Care Residents and Calls for Reducing Room Crowding | CMS.” CMS.Gov, 29 June 2022, www.cms.gov/newsroom/press-releases/cms-issues-significant-updates-improve-safety-and-quality-care-long-term-care-residents-and-calls.
Fundamentals of CMS Updates to Appendix PP of the State Operations Manual: Nursing Services
F725: Nursing Services
Noncompliance at deficiency tag F725 will be cited if the surveyors find that a facility does not have a sufficient number of skilled licensed nurses, nurse aides, and other nursing personnel to provide care and respond to each resident’s basic and individual needs, as required by the resident’s diagnoses, medical condition, or plan of care. Except when waived, facilities are also responsible for ensuring licensed nurse coverage 24 hours a day and for ensuring that a licensed nurse is designated to serve as a charge nurse on each tour of duty.
The SOM Revisions to F725 Direct the Surveyors to Assess the Sufficiency of Nursing Staff
The new SOM provides guidance to surveyors regarding how to assess whether nurse staffing is in line with federal standards. Facilities must ensure that there are enough licensed staff to provide direct services to residents, as well as to assist and monitor all the aides that the licensed staff are responsible for supervising.
“Fundamentals of CMS Updates to Appendix PP of the State Operations Manual: Nursing Services.” JD Supra, 27 Oct. 2022, www.jdsupra.com/legalnews/fundamentals-of-cms-updates-to-appendix-3122962.
PBJ Data Use in Surveys Serves as ‘Breadcrumbs’ to Looming Federal Staffing Mandate
The Biden administration, and its federal agencies, appear to be in lockstep in how they have been thinking and talking about nursing homes, industry leaders say, further evidenced by the latest release on the rules of participation for Medicare and Medicaid.
Specifically concerning the administration’s efforts to establish a minimum staffing ratio among facilities, the recently released guidance gives operators and advocacy groups a glimpse into agency efforts toward that end.
The Centers for Medicare & Medicaid Services (CMS) as part of its June 29 updates said Payroll-Based Journal staffing data will be used for inspections effective on Oct. 24.
Stulick, Amy. “PBJ Data Use in Surveys Serves as ‘Breadcrumbs’ to Looming Federal Staffing Mandate.” Skilled Nursing News, 10 July 2022, skillednursingnews.com/2022/07/pbj-data-use-in-surveys-serves-as-breadcrumbs-to-looming-federal-staffing-mandate.
Appendix PP Revisions in the State Operations Manual: Breaking Down Key Changes
On June 29, the Centers for Medicare & Medicaid Services (CMS) issued a major update to surveyor guidance via Quality, Safety and Oversight (QSO) memo QSO-22-19-NH to strengthen the implementation of the already-in-effect Phases 2 and 3 of the 2016 Reform of Requirements for Long-Term Care Facilities, as well as to update some guidance in response to stakeholder feedback and questions.
The wide-ranging update provides both revised guidance to surveyors (substantive as well as technical revisions) and new guidance to surveyors in the following areas of Appendix PP in the State Operations Manual.
Revises the following F-tags, particularly to assist surveyors to use PBJ data to identify low staffing concerns for deeper investigation:
“Appendix PP Revisions in the State Operations Manual: Breaking Down Key Changes.” AAPACN, 18 July 2022, www.aapacn.org/article/appendix-pp-revisions-in-the-state-operations-manual-breaking-down-key-changes
New employee interviews, deeper dive into PBJ data could lead to more survey citations
Nursing home operators should be on high alert about the questions surveyors will ask employees about sufficient staffing after heavy emphasis was placed on the matter in updated guidance released this week by the Centers for Medicare & Medicaid Services.
CMS now plans to incorporate Payroll Based Journal staffing figures into investigations about potential noncompliance with nurse staffing requirements. Surveyors will be looking for problems such as insufficient staffing, lack of a registered nurse for eight hours each day, and a lack of licensed nursing for 24 hours a day.
If surveyors develop concerns after research and staff interviews, they will be directed to dig deeper to determine the severity of noncompliance.
Brown, Danielle. “New Employee Interviews, Deeper Dive into PBJ Data Could Lead to More Survey Citations.” McKnight’s Long-Term Care News, 1 July 2022, www.mcknights.com/news/new-staff-interviews-deeper-dive-into-pbj-data-may-mean-more-fines.
It’s a month for fireworks, especially for long-term care
July. It always means one sure thing around this country: heightened anticipation of fireworks.
This year, more than ever, you could also call it a time for heightened fireworks anxiety. Especially since long-term care is getting an enhanced batch this year.
The first parcel actually came earlier this week in Wednesday’s release of the final Phase 3 guidance for the Requirements of Participation. At 876 pages, this whopper would require its own keg of gunpowder to send it flying. An idea more than a few providers might entertain soon enough.
Berklan, James. “It’s a Month for Fireworks, Especially for Long-Term Care.” McKnight’s Long-Term Care News, 30 June 2022, www.mcknights.com/daily-editors-notes/its-a-month-for-fireworks-especially-for-long-term-care.
Medicare, Medicaid to Take Closer Look at Nursing Home Staffing
CMS has updated guidance on minimum health and safety standards that long-term care facilities must meet to participate in Medicare and Medicaid. The guidance specifically addresses nursing home staffing concerns that some say have impacted care quality.
The agency also updated and created new guidance for surveyors of long-term care facilities who determine whether facilities comply with CMS requirements. The new requirements made as part of the recent update incorporate the use of Payroll Based Journal staffing data. CMS has instructed surveyors to use the data for long-term care facility inspections. The agency said the data will “help better identify potential noncompliance with CMS’s nurse staffing requirements,” including a lack of a registered nurse for eight hours each day.
“This guidance will help to uncover instances of insufficient staffing and yield higher quality care,” CMS added in the announcement.
LaPointe, Jacqueline. “Medicare, Medicaid to Take Closer Look at Nursing Home Staffing.” Revcycle Intelligence, 30 Jun. 2022, revcycleintelligence.com/news/medicare-medicaid-to-take-closer-look-at-nursing-home-staffing
CMS targets staffing, resident room capacities in updated RoP guidance
The Centers for Medicare & Medicaid Services appears to be weighing changes to its nursing home room capacity standards, based on recommendations included in updated guidance released Wednesday.
The issue was among several key topics addressed in a memo issued Wednesday for nursing home surveyors that updates guidance related to Phase 2 and Phase 3 of the Requirements of Participation.
CMS added new requirements for surveyors to incorporate the use of Payroll Based Journal staffing data for more thorough investigations into provider compliance with staffing requirements. The update comes just months after PBJ reporting expanded and as the agency works to establish new minimum staffing requirements for nursing homes.
Brown, Danielle. “UPDATED: CMS Targets Staffing, Resident Room Capacities in Updated RoP Guidance.” McKnight’s Long-Term Care News, 30 June 2022, www.mcknights.com/news/cms-targets-staffing-resident-room-capacities-in-updated-rop-guidance.
CMS Announces Updates to Improve Safety and Quality of Long-Term Care Facilities
The Centers for Medicare and Medicaid Services (CMS) has issued a number of updates for long-term care facilities regarding health and safety standards that must be met for their participation in both programs to continue.
The updates come as part of the Biden administration’s initiative to promote safety and improve the quality of long-term care facilities throughout the country.
“As the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve,” Chiquita Brooks-LaSure, CMS administrator, said in a statement.
HealthLeaders. “CMS Announces Updates to Improve Safety and Quality of Long-Term Care Facilities.” HealthLeaders Media, 30 June 2022, www.healthleadersmedia.com/post-acute/cms-announces-updates-improve-safety-and-quality-long-term-care-facilities.
CMS Updates Nursing Home Medicare Requirements of Participation Guidance, Furthers Biden Reform Agenda
The Centers for Medicare & Medicaid Services (CMS) on Wednesday issued updated guidance for nursing home surveyors under the requirements of participation for Medicare and Medicaid, and in support of nursing home reform initiatives first unveiled in February.
As providers and industry associations digested the updates, one familiar theme emerged: concern over new requirements and regulatory pressures at a time when the sector is still facing Covid-related challenges and a labor crisis.
Staffing and infection control are among the main areas of focus in the CMS guidance.
Stulick, Amy. “CMS Updates Nursing Home Medicare Requirements of Participation Guidance, Furthers Biden Reform Agenda.” Skilled Nursing News, 29 June 2022, skillednursingnews.com/2022/06/cms-updates-nursing-home-medicare-requirements-of-participation-guidance-furthers-biden-reform-agenda.
Updated Guidance for Nursing Home Resident Health and Safety
To further support the implementation of the Long-Term Care (LTC) Facilities Requirements for Participation, which were published in 2016, CMS is issuing surveyor guidance which clarifies specific regulatory requirements and provides information on how compliance will be assessed. In addition, CMS is revising its guidance to State agencies, to strengthen the management of complaints and facility reported incidents.
Today’s updates to guidance are just one piece of CMS’s ongoing effort to implement President Joe Biden’s vision to protect seniors by improving the safety and quality of our nation’s nursing homes, as outlined in a fact sheet released prior to his first State of the Union Address in March 2022.
Centers for Medicare & Medicaid Services. “Updated Guidance for Nursing Home Resident Health and Safety | CMS.” CMS News and Media Group, 29 June 2022, www.cms.gov/newsroom/fact-sheets/updated-guidance-nursing-home-resident-health-and-safety
Related CMS and PBJ Resources
To learn more about the details, policies and information in these articles, please review these CMS and PBJ publications.
QSO Memo 22-19-NH
Technical Users' Guide
July 2022
