Phase 2: Revised Nursing Home Interpretive Guidelines & Survey


  Arete Rehab is redefining successful aging.

Arete Rehab is redefining successful aging.

Phase 2 of Medicare’s revised nursing home interpretive guidelines and survey process is set to roll out November 28, 2017.  Here are the quick facts to get you up to speed in addition to some resources that can help provide more in depth answers to questions.

Why Are These Changes Occurring?

  • Overall process improvement to Medicare Surveys

  • Ensuring resident needs are met and that they are kept safe

  • Increasing provider competency to care for nursing patients and residents

  • Allowing increased transparency with consumers/residents to allow them to be more aware of their rights/nursing home processes

What are the Major Changes to the Regulations?

  • F-Tags are changing

    • new coding for Substandard Quality of Care (SQC)

  • Resident rights as related to Advanced Beneficiary Notices, Advanced Directives, Visitation Rights

  • Added guidance to Resident Abuse and Neglect including physical and chemical restraints, reporting process

  • Process for Admittance, Transfers, Discharges- Immediate Orientation and planning for DC

  • Resident Assessments- Integration with Resident Assessment Manual (RAI), coordinating PASARR

  • Comprehensive Resident-Centered Care Plan

    • Really identifying resident goals and needs to develop a post-DC plan that will allow person to adjust to home environment

  • Focus on Quality of Life with addition of pervasive disregard of principles tag that will be issued with widespread evidence of pattern

  • Quality of Care updates- specific bed rail addition as related to malfunctions

  • Nursing Services/Food and Nutrition Services-sufficient number and competency of staff

  • Behavioral Health Services-integrates dementia-identifying these needs in individualized/appropriate manner, utilizing non-pharmacological interventions, assuring staff competency

  • Pharmacy Services:

    • reducing use of unnecessary meds

    • Psychotropic meds- can be extended with MD order

    • Antipsychotic meds-require physician eval prior to extending

  • Administration:

    • Added Facility Assessment

    • Expanded Medical Director language to allow for NP, PA, or clinical RN specialist to be in role

  • QAPI- requirement of QAPI Plan document that demonstrates ongoing facility monitoring, identifying issues, development of corrective plan

  • Infection Control-Antibiotic Stewardship Program, new standards for infection control

  • Physician Services-changes to language

  • Dental Services-policy on denture replacement if caused by facility

  • Physical Environment-smoking policy and room size as related to reconstruction

  • Training

What are the Major Changes to the Survey Process?

  • Universal computerized system that all states will use

  • Major Focus of Survey:

    • Sufficient/Competent Staffing

    • Infection Control

    • Beneficiary Notices

    • Dining Observation

    • Medication Storage

    • Medication Administration

    • Kitchen Observation

    • QAA/QAPI

  • Day 1

    • Pool selected: 70% offsite selection, 30% onsite selection

      • All residents to be screened in assigned area, completion of a Resident and Family Interview/Observations, Limited Record Reviews for residents selected for the initial pool

    • Process upon arrival:

    • Census and list of all residents, with identification of new admissions, All Documents per Previous process, Policies and Procedures, Meal and medication administration times, Access to Electronic Health Records, Updated facility matrix