Ask the payment expert: new state guidelines on pain management

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Ask the payment expert
Ask the payment expert
It seems like our state has been focusing on pain management. Do the new guidelines change anything?

Probably the biggest change is the need to focus on anticipated pain, also called incident pain.  This is the pain a resident feels due to a procedure or treatment, such as therapy care or another service.

You need to plan for this incident pain and try to prevent it. This means building into your care plan the identification and interventions to implement prior to the service. This isn't just the job of the nurse but also the aide who might need to delay personal care until the pain medication begins to work.

Read the guidance thoroughly, review your assessment and make sure it meets all the assessment components. Staff education is essential.

You can find the new guidelines in Appendix PP at

Did you know if we can expect any other new guidelines?

CMS did publish an Advanced Copy of Interpretive Guidelines related to quality of life. This document covers a variety of F-tags and does not drastically change what surveyors have been looking for. However, it puts into writing some issues related to resident choice and preferences.

Some areas include visiting hours, dining room protocols and roommate choices. The guidelines clarify that residents can choose to accept food from visitors, which has been a barrier since F-371 was published.

You need to read the advanced guidance, which goes into effect this month (June 17). 

You can find the advanced copy at