Phase 2 requirements for skilled nursing facilities and nursing homes went into effect this week, but the Centers for Medicare & Medicaid Services won’t assign civil monetary penalties for noncompliance just yet.
Late last week, CMS announced that it will extend the enforcement delay for certain Phase 2 requirements to 18 months “to address concerns regarding the scope and timing of the revised requirements.” The agency noted that it will use this 18-month period to educate surveyors and long-term care providers to ensure they understand the health and safety expectations that will be evaluated through the survey process.
Earlier this year, CMS extended the enforcement delay by 12 months; but that has now been extended to 18 months for certain F-Tags to ensure provider understanding and readiness. CMS emphasizes that although civil monetary penalties will not be assigned for noncompliance with certain Phase 2 requirements during this 18-month time period, the delay does not affect the implementation date of Phase 2 requirements and surveyors have been instructed to cite tags as appropriate.
The 18-month delay applies to the following F-Tags:
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F655 (Baseline Care Plan); §483.21(a)(1)-(a)(3)
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F740 (Behavioral Health Services); §483.40
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F741 (Sufficient/Competent Direct Care/Access Staff-Behavioral Health); §483.40(a)(1)-(a)(2)
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F758 (Psychotropic Medications) related to PRN Limitations §483.45(e)(3)-(e)(5)
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F838 (Facility Assessment); §483.70(e)
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F881 (Antibiotic Stewardship Program); §483.80(a)(3)
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F865 (QAPI Program and Plan) related to the development of the QAPI Plan; §483.75(a)(2) and,
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F926 (Smoking Policies). §483.90(i)(5)
CMS noted that it is not extending the enforcement deadline for F608, which addresses reporting reasonable suspicion of a crime, due to the concerns about significant resident abuse going unreported.
CMS’ memo also stated that because most facilities will be surveyed for compliance with Phase 2 requirements using the LTC revised survey, and as a result of the differing standards and process between those facilities surveyed under the new survey process compared to prior surveys, the agency will be holding constant, or “freezing,” the health inspection star rating for health inspection surveys and complaint investigations conducted on or after November 28, 2017. CMS expects this freeze to begin in early 2018, and last approximately one year.
Additionally, beginning in early 2018, CMS plans to provide summaries of a facility’s most recent survey findings, such as the total number of deficiencies cited and the highest scope and severity level cited, on Nursing Home Compare (NHC). “These types of changes are rare, and the Five Star Quality Rating System and Nursing Home Compare website remain an excellent source for information about nursing homes,” said CMS in their memo.
In the future, CMS plans to include new staffing data from the Payroll-Based Journal Program on the NHC site.
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