In a new memo (QSO-26-03-NH, Jan. 30), the Centers for Medicare and Medicaid Services (CMS) is advising state survey directors of a slew of changes that will impact how surveys are conducted operationally and updating the regulatory mechanisms to do so.

The memo outlines CMS guidance on the following changes effective March 30:

-          Revisions to Immediate Jeopardy Priority Definition examples for Nursing Homes

-          Clarification of Off-site investigations

-          Survey Team Composition, Survey Procedures, Plans of Correction, Verifying Corrections, Survey Revisit and Offsite Revisit Paper Review, Off-hours Survey, Enforcement, Nurse Staffing Waivers, Disposition of Civil Money Penalties, Federal Civil Penalties Inflation Reduction Act, Informal Dispute Resolution, and Independent Informal Dispute Resolution

-          Technical changes that include updates for accurate references

Conducting a Survey

An example of the new guidance is the composition of the survey team, which CMS should be configured based on a building’s prior noncompliance and complaint history, with specialists on hand as needed.

To Alicia Cantinieri, managing director, clinical reimbursement and regulatory compliance, Zimmet Healthcare Services Group, another example in the new guidance she finds significant is CMS's requirement that off-site investigations receive advance CMS approval to ensure consistent and uniform application.

“CMS also clarified which intake allegations must be prioritized when immediate jeopardy may have occurred, regardless of whether the immediate risk is believed to be ongoing,” she said.

These include allegations of abuse resulting in serious harm or death, situations in which there is a reasonable likelihood of harm and uncertainty as to whether the resident has been adequately protected, and newly added scenarios such as the discharge of a resident to an unsafe location where the individual's medical needs cannot be met.

Nurses Onboard

The memo said surveyors must also have mastered the Surveyor Minimum Qualifications Test to be able to conduct surveys on their own and that an RN must be a member of the multidisciplinary team for initial and recertification surveys, among other further guidance. 

“I am pleased that the updated guidance now requires both initial and recertification survey teams to include an RN, which is essential to a comprehensive and effective survey process. RNs bring clinical expertise necessary to accurately assess resident acuity, nursing assessments, care planning, medication management, and the appropriateness of clinical interventions,” Cantinieri said.

An interdisciplinary survey team that includes an RN strengthens the ability to identify quality-of-care concerns and evaluate compliance with clinical standards, she added.

Read the CMS memo at https://tinyurl.com/3w8fzwdy.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.