The Centers for Medicare and Medicaid Services (“CMS”) recently released Administrative Information 24-05-NH to provide guidance to surveyors on areas of focus for Federal Monitoring Surveys (“FMS”). The document identifies National Concern Areas based on internal CMS data sources, OIG recommendations, and the White House Initiative to Improve Care in Nursing Homes. Also, CMS locations may identify additional areas of concern for states within their jurisdiction.
For FY24 and FY25, CMS has identified three National Concern Areas for Long Term Care (“LTC”):
|Critical Element Pathway
- F851: Payroll Based Journal
|Sufficient and Competent Nurse Staffing
|Nursing Services (§483.35)
- F725: Sufficient Staff
- F727: RN 8 Hrs./day, 7 days/Wk., Full Time DON
|Unnecessary Psychotropic Medication
|Resident Assessments (§483.20)
- F641 Accuracy of Assessments
- Unnecessary Medications
- Psychotropic Medications
- Medication Regimen Review
|Comprehensive Resident Centered Care Plans (§483.21)
- F658: Services Provided Meet Professional Standards
|Pharmacy Services (§483.45)
- F758: Free from Unnecessary Psychotropic Meds/PRN Use
|Admission, Transfer, and Discharge (§483.15)
- F622: Transfer and Discharge Requirements
- F624: Preparation for Safe/Orderly Transfer/Discharge
- F626: Permitting Residents to Return to Facility
The information document further explains the types of federal oversight surveys that are required. There are three types of Health FMS:
- Resource and Support Surveys are surveys for which one or more Federal Surveyors accompany the State Agency surveyors on an initial, standard, revisit, or complaint survey to assess and observe the overall State Agency surveyor team performance and performance related to specific areas of concern.
- Focused Concern Surveys are one of the evaluative components of the FMS process. They include conducting an independent investigation of the identified concern areas.
- Health Comparative Surveys are full surveys conducted by the Federal Surveyors in the same facility after a standard survey is conducted by the State Agency.
In addition to the LTC FMS, the LTC Life Safety Code (“LSC”) and Emergency Preparedness FMS are comprised of four survey processes aimed at advising and evaluating State Agency surveyors:
- A LSC Resource and Support Survey is a survey in which one or more Federal Surveyors will observe and assess the State Agency survey team performance with respect to LSC issues.
- A LSC Comparative is a full survey conducted by one or more Federal Surveyors in the same facility after a standard survey is conducted by the State Agency.
- A LSC Revisit Resource and Support Survey is a survey in which the Federal Surveyor(s) will observe and assess the State Agency survey team performance.
- A LSC Revisit Comparative is a survey conducted by one or more Federal Surveyors in the same facility after a revisit survey is conducted by the State Agency for the purpose of monitoring and evaluating the State Agency survey team performance.
Federal Monitoring Surveys are required for at least 5% of those skilled nursing facilities surveyed by the state in the year, but in no case less than five skilled nursing facilities in the state.
Although providers are generally accustomed to being “survey-ready” at all times, the specter of FMS means that they cannot breathe a sigh of relief when a State Agency survey is over. Rather, providers must learn to anticipate a Federal Oversight Survey in conjunction with or after any State Agency survey. LTC providers face numerous and ongoing challenges, and the Federal Oversight Surveys continue to reflect the cumbersome regulations and extensive survey processes that impact the overall LTC Industry; however, they proactively can (and should) focus on the areas of concern identified in the information document.