On November 24 the Survey and Certification Group (S&C) at the Centers for Medicare and Medicaid Services (CMS) issued two memos that further delay enforcement of provisions of the Phase 2 Requirements of Participation, falls short of the complete delay sought by AHCA. These memos indicate that CMS is delaying some enforcement provisions of the Phase 2 requirements, but CMS will proceed with implementing the new survey process effective November 28, 2017.

According to AHCA President and CEO Mark Parkinson, “We are disappointed that CMS did not take additional steps to delay the new survey process and the full implementation of the new requirements. The memos indicate that CMS has taken several of our concerns into consideration but we must continue to push for additional change as the requirements and survey process are implemented.”

Phase 2 Requirements Impacted by the Temporary Enforcement Moratorium

S&C Memo 18-04-NH: Temporary Enforcement Delays for Certain Phase 2 F-Tags and Changes to Nursing Home Compare

• Temporary moratorium on imposing certain enforcement remedies for specific Phase 2 requirements: CMS will provide an 18-month moratorium on the use of certain enforcement remedies (CMP, DPNA and discretionary termination) for specific Phase 2 requirements (see below). However, CMS may use directed plans of correction or directed inservices for these specific Phase 2 requirements. This 18-month period will be used to educate facilities about specific new Phase 2 standards.
• Freeze Health Inspection Star Ratings: Following the implementation of the new survey process on November 28, 2017, CMS will hold constant the current health inspection star ratings on the Nursing Home Compare website for any surveys occurring between November 28, 2017 and November 27, 2018. There is no change to the staffing or quality measure component and the overall rating can still change based on your staffing and quality measure component.
• Availability of Survey Findings: The survey findings of facilities surveyed under the new survey process will be published on Nursing Home Compare, but will not be incorporated into calculations for the Five-Star Quality Rating System for 12 months. CMS will add indicators to Nursing Home Compare that summarize survey findings.
• Methodological Changes and Changes in Nursing Home Compare: In early 2018, Nursing Home Compare health inspection star ratings will be based on the two most recent cycles of findings for standard health inspection surveys and the two most recent years of complaint inspection.

CMS has provided the following list of F-Tags included in the 18-month moratorium on use of CMPs:

• F655 (Baseline Care Plan); §483.21(a)(1)-(a)(3)
• F740 (Behavioral Health Services); §483.40F741 (Sufficient/Competent Direct Care/Access Staff-Behavioral Health); §483.40(a)(1)-(a)(2)
• F758 (Psychotropic Medications) related to PRN Limitations §483.45(e)(3)-(e)(5)
• F838 (Facility Assessment); §483.70(e)
• F881 (Antibiotic Stewardship Program); §483.80(a)(3)
• F865 (QAPI Program and Plan) related to the development of the QAPI Plan;
• 483.75(a)(2) and,
• F926 (Smoking Policies). §483.90(i)(5)

Five-Star Rating System Changes

Five-Star Rating changes will only be frozen for any surveys or IDRs that are initiated after November 28, 2017. Any survey or IDR that was initiated before November 28, 2017 will continue to impact facility Five-Star Ratings. Survey results, including the number, type and severity of deficiencies, will continue to be posted on Nursing Home Compare. The memo also states that in early 2018, CMS intends to recalculate all Five-Star Ratings, excluding the third oldest survey from every rating. After that time, only the past two surveys will be included in the rating system. 

CMS recommends that providers impacted by this freeze that are involved with ACOs or managed care provide a copy of this memo to the ACO or hospital.

New Survey Process

S&C Memo 18-05-NH: Preparation for Launch of New Long-Term Care Survey Process (LTCSP)

The second memo, Preparation for Launch of New Long-Term Care Survey Process, confirms that CMS will begin the new survey process on November 28, 2017. The memo provides guidance to state surveyors as they implement the new survey.

As facilities are preparing for the new survey process to begin this week, AHCA has developed a free three-part series on ahcancalED to understand what an owner or CEO needs to know about the new regulations that go into effect on November 28. Presented by Dr. David Gifford, AHCA Senior Vice President of Quality & Regulatory Affairs, and designed specifically for owners and CEOs, this new series will provide an overview of what to expect.

• Part 1: Overview and key themes
• Part 2: Overview of the new survey process
• Part 3: Key questions to ask your management team to make sure your organization is ready

To access this exclusive member benefit, visit ahcancalED and register using your AHCA username and password. If you need additional assistance or have any questions, please contact the ahcancalED team at educate@ahca.org.

AHCA has had ongoing discussions with CMS officials and Administrator Seema Verma about the content and implementation of the Phase 2 Requirements of Participation and the new survey process. They know that there are many concerns with the new requirements, even with the changes we have successfully fought for up to this point. CMS has indicated a willingness to continue to work with us as the requirements go into effect. AHCA will continue its efforts to find solutions that help you provide quality care.