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CMS Announces Updates to Improve Safety and Quality of Long-term Care Facilities

Analysis  |  By Jasmyne Ray  
   June 30, 2022

The updates will go into effect in October to allow facilities and surveyors time to train.

The  Centers for Medicare and Medicaid Services (CMS) has issued a number of updates for long-term care facilities regarding health and safety standards that must be met for their participation in both programs to continue.

The updates come as part of the Biden administration’s initiative to promote safety and improve the quality of long-term care facilities throughout the country.

“As the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve,” Chiquita Brooks-LaSure, CMS administrator, said in a statement.

The following is a summary of the most significant changes (per a CMS press release):

  • Abuse and neglect – clarifies compliance, abuse reporting, including sample reporting templates, and provides examples of abuse that, because of the action itself, would be assigned to certain severity levels
  • Admission, transfer, and discharge – clarifies requirements related to facility-initiated discharges
  • Mental health/substance use disorder (SUD) – addresses rights and behavioral health services for individuals with mental health needs and SUDs
  • Nurse staffing (payroll-based journal) – uses payroll-based staffing data to trigger deeper investigations of sufficient staffing and added examples of noncompliance
  • Resident rights – imports guidance related to visitation from memos issued related to COVID-19, and makes changes for additional clarity and technical corrections
  • Potential inaccurate diagnosis and/or assessment – addresses situations where practitioners or facilities may have inaccurately diagnosed/coded a resident with schizophrenia in the resident assessment instrument
  • Pharmacy – addresses unnecessary use of non-psychotropic drugs in addition to antipsychotics, and gradual dose reduction
  • Infection control – requires facilities to have a part-time infection preventionist (IP); though the requirement is to have at least a part-time IP, they must meet the needs of the facility and physically work onsite
  • Arbitration – clarifies existing requirements for compliance when arbitration agreements are used by nursing homes to settle disputes
  • Psychosocial Outcome Severity Guide – clarifies the application of the “reasonable person concept” and severity levels for deficiencies
  • State Operations Manual Chapter 5 – clarifies timeliness of state investigations, and communication to complainants to improve consistency across states.

Additionally, CMS highlighted the benefits of reducing the number of residents in each room to prevent infections, emphasizing the importance of residents’ rights to privacy and a homelike environment.

The updates will go into effect on Oct. 24 to allow surveyors and facilities enough time to be trained on the new information.

“As the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve.”

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 


  • The updates are part of an effort by the Biden administration to improve the safety and quality of care in nursing homes.
  • Long-term care facilities will now have to have an infection preventionist working onsite at least part-time.
  • To decrease and slow the spread of infection, CMS suggests reducing the number of residents in each room.

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