CMS puts 18-mo. hold on certain enforcements, 5-star ratings

The Centers for Medicare & Medicaid Services (CMS) has decided to institute an 18-month delay for the enforcement actions on certain Phase 2 F-Tag requirements, although the new long-term care survey process begins this week as scheduled.

While the delay will affect penalties and enforcement actions, it does not change the required implementation timeline of the Phase 2 requirements.

The moratorium, announced via a CMS memo, includes a hold on civil money penalties, denials of payment for new admissions and discretionary termination in relation to the following eight F-Tags:

  • F655 (Baseline Care Plan); §483.21(a)(1)-(a)(3)
  • F740 (Behavioral Health Services); §483.40
  • F741 (Sufficient/Competent Direct Care/Access Staff-Behavioral Health);§483.40(a)(1)-(a)(2)
  • F758 (Psychotropic Medications) related to PRN Limitations §483.45(e)(3)-(e)(5)
  • F838 (Facility Assessment); §483.70(e)
  • F881 (Antibiotic Stewardship Program); §483.80(a)(3)
  • F865 (QAPI Program and Plan) related to the development of the QAPI Plan; §483.75(a)(2)
  • F926 (Smoking Policies); §483.90(i)(5)

The CMS temporary delay does not include remedies required by federal law, including immediate jeopardy and any set time limits set for achieving compliance under sections 1819 (h)and 1919 (h) of the Social Security Act. Facilities cited with deficiencies of immediate jeopardy must comply within the timeframe set by the surveying officer.

CMS also will temporarily freeze the five-star ratings from Nov. 28, 2017 to Nov. 28, 2018. The application for an Informal Dispute Resolution (IDR) also will be frozen for one year, starting Nov. 28, 2017. This one-year delay in the inclusion of data gathered under the new survey process will give facilities and surveyors a chance to standardize their processes.

“CMS will use this 18-month moratorium period to educate surveyors and the providers to ensure they understand the health and safety expectations that will be evaluated through the survey process since these Phase 2 requirements are associated with unique and separate tags where specialized efforts and technical assistance may be needed,” notes the CMS memo. “The changes explained in the memorandum serve a temporary need to accommodate the implementation of the first major regulatory change to the LTC requirements in over 25 years.”

The new long-term care survey process began Nov. 28 as planned. The results of the surveys will be published on the Nursing Home Compare site as planned, but will not be calculated as part of the five-star ratings process until November 2018.

Other types of measures, including Phase 1 F-Tags, will continue to actively impact a facility’s five-star rating throughout the delay period on the above F-Tags.

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