Making Sense of the New F-Tags and Interpretative Guidance
During the August 22-23 education program, Bringing the New Requirements of Participation into Focus, we’ll help you make sense of the new F-Tags and the interpretive guidance which clarifies Phase 1 requirements and offers insight into Phase 2. In the meantime, we’ve prepared a summary of S&C Memo 17-36-NH, which includes the new interpretive guidance and F-Tags, as well as forthcoming changes to the survey process.
Revised Interpretive Guidance
In September 2016, the Centers for Medicare & Medicaid Services (CMS) released revised Requirements for Participation under the Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities rule. CMS is releasing revised Interpretive Guidance to be effective November 28, 2017, which includes clarifications to existing requirements, guidance for new Phase 2 requirements, and references to the revised survey process and protocols.
Revised F-Tags
The revisions to the regulations caused many of the prior regulatory citations to be re-designated. Given the re-structuring of the regulation, some tags were combined, and some tags were split into multiple subparts. As such, CMS was required to re-number the F-Tags used to identify each regulatory part. The new F-Tags will be used after November 28, 2017.
- List of revised F-Tags (substandard quality of care noted in red)
- Phase 2 F-Tag Crosswalk
Survey Process
In addition, implementation of Phase 2 is scheduled to occur simultaneously with a new, computer-based long term care survey system. CMS is incorporating the new regulatory requirements while combining the traditional and Quality Indicator Survey (QIS) processes. Within the Interpretive Guidance, there is information about the survey process. CMS will be making additional materials available in the coming months.
Training Resources
Between July and October 2017, CMS will provide a number of trainings for state survey agencies, nursing facilities and the public to understand and meet the new requirements of the survey process and regulations.
Enforcement and Nursing Home Compare Considerations
To address concerns related to the scope and timing of the changes, CMS will be providing limited enforcement remedies for certain Phase 2 provisions. Specifically, CMS will not utilize civil money penalties, denial of payment, and/or termination. Should a facility be found to be out of compliance with these new requirements beginning in November of 2017, CMS would use this year-long period to educate facilities about certain new Phase 2 quality standards by requiring a directed plan of correction or additional directed in-service training. Enforcement for other existing standards (including Phase 1 requirements) would follow the standard process. Please note, this one-year period is not a change in the required implementation date for Phase 2 provisions. CMS expects to share the list of specific Phase 2 requirements associated with enforcement delays at a later date.
Due to the differing standards being phased in over the year, CMS will hold the Nursing Home Compare health inspection rating constant for one year for any surveys conducted after November 28, 2017. CMS has done this previously where the star ratings are maintained for a period of time as new requirements implemented. To address the concern that serious quality concerns will not be known, CMS will separately flag those nursing centers to ensure public transparency. CMS will provide more detailed methodology information at a later date.
As a reminder, additional information and resources can be found on our Requirements of Participation webpage.
