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, as well as  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 noncompliance 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.

To learn more about the changes, plan to join us each Thursday beginning Sept.8 – Oct 6 for our upcoming webinar series Unpacking the RoP Interpretive Guidance: LTC Implementation Essentials. This education series will offer clarity on each of the updates and regulatory changes with in-depth guidance on developing actions plans for achieving compliance in advance of the October 24th implementation date.

Learn more and register.



Written By: Shelly Maffia, RN, MSN, MBA, LNHA, QCP, CHC, CLNC, CPC

Director of Regulatory Services

Learn more about the rest of the Proactive team.