On June 29, 2022, CMS issued QSO-22-19-NH, announcing the release of new Interpretive Guidance for Phase 3 requirements, which went into effect November 28, 2019, and revisions to Phase 2 guidance. Surveyors will begin using this guidance to identify noncompliance on October 24, 2022. Significant revisions to the guidance include:

      • Revisions to the guidance for Abuse/Neglect in Appendix PP that include clarifications about facility reported incidents (FRIs), including examples of cases and what information should be reported.
      • Clarifications regarding discharges initiated while a resident is in the hospital following an emergency transfer and the requirements related to providing notice of a transfer or discharge.
      • Guidance related to caring for residents with mental health needs and substance use disorders.
      • Guidance that incorporates the use of Payroll Based Journal (PBJ) staffing data to direct surveyors to investigate potential non-compliance with CMS’ nurse staffing requirements, such as insufficient staffing, lack of a registered nurse for eight hours each day, or lack of licensed nursing for 24 hours a day.
      • Revised guidance related to visitation restrictions.
      • Revised guidance to investigate situations where practitioners or facilities may have potentially inaccurately diagnosed and/or coded a resident with schizophrenia in the resident assessment instrument.
      • Revised guidance addressing medications not defined as psychotropic medications, but that affect brain activity and can also have adverse consequences.
      • New guidance related to Infection Preventionist requirement.
      • New guidance on the arbitration requirements, which became effective September 19, 2019.
      • Revisions to the guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and FRIs.
      • Revisions to the Psychosocial Outcome Severity Guide to assist surveyors in applying the guidance and categorizing a deficiency at the appropriate severity level.

Save the date to join Proactive for a comprehensive webinar series running 5 consecutive Thursdays beginning September 8, 2022-October 6, 2022 to unpack the updated LTC Surveyor Guidance. This training will include implementation strategies and tools to ensure compliance for October 24th implementation.  More details and registration information coming soon on our website.



Shelly Maffia, RN, MSN, MBA, LNHA, QCP, CHC, CLNC, CPC
Director of Regulatory Services

Learn more about the rest of the Proactive team.