Revised Long-Term Care Surveyor Guidance (Jun 2022)

CMS Quality Safety & Oversight Memorandum
PUBLISHED: June 29, 2022
CMS LISTING: Quality, Safety and Oversight Letter 22-19-NH

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Memorandum 22-19-NH – issued June 29, 2022 – substantially 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.

CMS is released guidance and associated training for nursing home surveyors in June 2022 for Phase 2 and Phase 3 Requirements.  Included in this memo are clarifications and technical corrections of Phase 2 guidance issued in 2017, and new guidance for Phase 3 requirements which went into effect in November 28, 2019.

The effective date for surveyors to begin using this guidance to identify noncompliance is October 24, 2022.

In prior Phase 2 guidance, CMS . incorporated the use of Payroll Based Journal (PBJ) staffing data submitted by providers to help inform surveyors of potential staffing concerns.

In this new guidance, CMS begins the use of Payroll Based Journal (PBJ) staffing data to direct surveyors to investigate potential noncompliance with CMS’ nurse staffing requirements, such as

  • insufficient staffing
  • lack of a registered nurse for eight hours each day, or
  • lack of licensed nursing for 24 hours a day.

Further, CMS clarified that the intent of the requirements for F-tags at §483.35, Nursing Services, by adding examples for deficiency categorization and added guidance at §483.70(q), F-tag 851 to provide guidance to surveyors to cite noncompliance with the Payroll Based Journal reporting requirements.

The QSO memorandum summarizes the changes, while the full details are found in the State Operations Manual – Appendix PP