Headshot of CMS Administrator Chiquita Brooks-LaSure
CMS Administrator Chiquita Brooks-LaSure

The Centers for Medicare & Medicaid Services on Wednesday released updated guidance for nursing home surveyors as part of the Phase 2 and 3 Requirements of Participation. 

Among key topics addressed are hiring infection preventionists, nurse staffing reinforcement, preventing resident abuse and neglect and practical guidance for surveyors. The memo comes a day after Evan Shulman, director of CMS’ nursing home division, told attendees at the 35th national NADONA conference that updates were imminent.

Infection preventionist

The updated guidance provides more information on how to implement the infection preventionist requirements for Phase 3. CMS said while the requirement is to have an IP at least part-time, facilities must have an effective infection prevention and control program and should ensure the role of the IP is tailored to meet the facility’s needs.

“With emerging infectious disease such as COVID-19, CMS believes the role of the IP is critical in the facility’s efforts to mitigate the onset and spread of infections,” the agency wrote in the memo.

Staffing and room requirements

White it continues to work on establishing new staffing minimums, CMS added new requirements for surveyors to incorporate the use of Payroll Based Journal staffing data for their inspections.

“This will help better identify potential noncompliance with CMS’s nurse staffing requirements, such as lack of a registered nurse for eight hours each day, or lack of licensed nursing for 24 hours a day,” the agency said in a statement. “This guidance will help to uncover instances of insufficient staffing and yield higher quality care.” 

The agency said surveyors were to start using the updated Sate Operations Manual Oct. 24.

The memo also includes recommendations related to resident room capacity, though there are no updated regulations at this time. “CMS is highlighting the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and homelike environment,” the agency said in a fact sheet.

Currently, CMS allows up to four residents in one room that allows for a minimum of 80 square feet per resident. Bedrooms in newly constructed or renovated facilities must accommodate no more than two residents, according to 2016 CMS guidance.

In response to President Joe Biden’s nursing home reform proposals, the agency plans to align its resident room requirements more inline with the 2016 guidance, CMS wrote. It’s also urging providers consider making changes to their physical environment to allow for a maximum of double occupancy in each room, and explore more ways to add more single occupancy rooms for residents.

“This also builds on the lessons learned through the COVID19 pandemic, where having more residents in a room can make it more challenging to prevent the transmission of infectious diseases,” the agency wrote.

Surveyor response to complaints

The updated guidance clarifies CMS’s expectations for ensuring timely investigations. This will help address findings from the Government Accountability Office which noted variation among states in reporting, tracking and processing reports of abuse and neglect.

Specifically, it updates the complaint procedures section (Chapter 5) of the State Operations Manual for surveyors in a push to strengthen the oversight of nursing home complaints and facility-reported incidents. The updates also aim to improve consistency across the state agencies in their communication to complainants.

Updated data entry requirements now ensure that state survey agencies collect information related to complaints and facility-reported incidents, and uses a system to track and monitor the receipt and disposition of complaint and incident intakes.

The guidance also dictates that for nursing homes, in situations where a determination is made that immediate
jeopardy may be present and ongoing, the state survey agency must start an on-site investigation within three business days of receipt of the initial complaint or incident report.

“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,” CMS Administrator Chiquita Brooks-LaSure said in a statement Wednesday. “CMS is proud to be leading President Biden’s initiative to improve the safety and quality of care in the nation’s nursing homes, and this set of improvements is our next step toward that goal.”

The updated guidance will go into effect on Oct. 24, 2022. “This will allow for ample time for surveyors and facilities to be trained on this new information,” CMS said.

This is a breaking news story. Please check back for additional updates.