AGING AND DISABILITY SERVICES ADMINISTRATION

2006 NH "Dear Administrator" Letters

May 25, 2006

ADSA: NH #2006-014
Changes TO Federal Guidance IN STATE OPERATIONS MANUAL (SOM)

Dear Nursing Facility/Home Administrator:

See update to this letter – ADSA: NH #2006-016

The Centers for Medicare and Medicaid Services (CMS) has revised specific steps within survey and post revisit surveys, certain guidance for long-term care surveyors as written in the State Operations Manual (SOM). The regulatory language remains unchanged; however there will be significant changes to some definitions in the Guidance to Surveyors, new investigative protocols, and revisions to the compliance and severity guidance tools. Implementation of all changes is scheduled for June 1, 2006.

On March 10 and May 1, 2006 CMS issued advance memos (Survey & Certification Letters) in order to permit state agencies and facilities to study these changes prior to implementation. The CMS website is the best source for accessing the most current information available. Two issuances apply to specific F-tags; one issuance clarifies changes to severity guidance related to all F-tags and the final issuance incorporates the previous changes into the survey process. Listed below are the topics and corresponding CMS letters, accessible online here.

Activities (F248 and 249)	S&C 06-09
Quality Assessment and Assurance (F520 and 521)	S&C 06-11
Changes to Appendix P- Survey and Post Revisit Process	S&C 06-13

The changes in the guidance should assist you, your staff and your Quality Assurance Committee in understanding the expectations of CMS. Nursing home surveyors will begin using the updated F-tags, protocols, and the compliance and severity guidance beginning June 1, 2006.

Implementation is delayed on the following while CMS considers stakeholder concerns:

Psychosocial Outcome Severity Guide

S&C 06-10

As always, RCS considers both the physical and psychosocial well-being of the resident when conducting surveys.

Thank you for your continued commitment to the nursing home residents in the state of Washington.

Sincerely,

Joyce Pashley Stockwell, Director
Residential Care Services