Image of woman visiting her grandmother in isolation during a coronavirus pandemic

Skilled nursing providers in late October began grappling with major changes to rules governing their everyday operations, with new surveyor guidance that went live Oct. 24.

Updates to the Centers for Medicare & Medicaid Services’ Requirements of Participation had been in the works since 2016, but final elements were delayed through a change in presidential administrations and the pandemic.

More than 800 pages of guidance, announced in June and now in effect, focus on major areas such as staffing, infection control, resident rights, abuse and neglect, trauma-informed care, substance-use disorder and room requirements.

The guidance calls on states to more quickly investigate complaints where residents could be in immediate jeopardy. Providers expressed concerns in October about potential increases in citations for behavioral health and rights violations.