On June 29, CMS released the long-awaited surveyor guidance on phase 3 of the Requirements of Participation (RoPs) with an implementation deadline of October 24, 2022. Access CMS memo QSO-22-19-NH on this release and associated attachments here. Phase 3 went into effect in November 2019 and nursing homes have waited more than 3 years for the guidance for how surveyors will interpret the requirements. The lack of guidance has largely put implementation of RoPs 3 on hold, though CMS has advised that nursing homes should be working toward compliance with the elements of the rule that are more straight-forward and nursing homes have been surveyed on the requirement to designate an infection preventionist. With the release of this guidance, providers can now aim to meet compliance with all Phase 3 requirements by the new implementation deadline of October 24, 2022.

In addition to the RoPs 3 guidance, CMS also issued revisions to sections of existing guidance such as abuse and neglect, including revision of the Psychosocial Outcome Severity Guide used to determine severity level when citing abuse and neglect. Admission, transfer and discharge guidance has been revised and lessons learned from the COVID-19 public health emergency have been integrated into sections on Resident Rights (visitation) and Infection Prevention. Continuing their work on unnecessary psychotropic medications including antipsychotics, CMS updated Pharmacy Services, and new information was added to direct surveyors in using data from the payroll-based journal (PBJ) to identify staffing issues and enforce compliance with PBJ reporting requirements.

Additionally, CMS released guidance on the use of arbitration agreements relative to the September 2019 requirements, and revised Chapter 5 of the State Operations Manual that relates to investigations of complaints and Facility Reported Incidents (FRIs).

Training on new guidance is now available for surveyors and providers on the Quality, Safety, and Education Portal (QSEP) site. CMS is working to update the Critical Element Pathways, which will be released ahead of the October implementation date.

LeadingAge will release more detailed information, tools, and resources for compliance on each of the revised sections in coming days.