PBJ QSO Memorandums Archives

CMS communicates major policy changes, survey focus requests and nursing home staffing goals through memorandum and letters to its survey and compliance partners in the field.

These changes are not exclusively announced in QSO Memorandums. Any new policies also get documented in the PBJ Policy Manual and FAQs and/or the Five Star QRS Technial Users Guide and/or the Federal Register.

These QSO memoranda, guidance, clarifications and instructions are sent to State Survey Agencies and CMS Regional Offices.

State Survey Agencies are responsible for the survey (inspection) to determine if nursing homes are complying with the prescribed health and safety standards under the agreements in Section 1864 of the Social Security Act (the Act) and collectively known as the certification process.

They are typically rom the Director of CMS’ Quality, Safety & Oversight Group. Prior to 2019, they were sent from the Director of CMS’ Survey and Certification Group (before it was renamed).

QSO Memorandums answer an important question about new CMS policies: "Why?".

You can track changes to the PBJ Policy Manual and the Five Star Technical Users Guide to find out "what" changed. And "when" the changes become effective.  However, those changes are very technical in nature, and do not come with any explanation for the rationale or objective that triggered the change.

We monitor QSO Memorandums to distill a deeper understanding of the policy or regulation change. Often our experience is these changes signal future enforcement or compliance focus. Closely monitoring CMS' explanations in these Memorandums enable the reader to stay prepared.

Take a course in the PBJ Academy for a practical hands-on understanding of the PBJ manual in real-life.

Browse our QSO Memorandums archive to view prior versions of the PBJ manual and see how it changed over time.

Read our History of QSO Memorandums for a look into the last 10 years of policy changes (requires login).