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SNFs, Are You Ready for the October 24 Survey Changes?

On Oct. 24, 2022, surveyors will begin using new survey guidance to identify noncompliance with QAPI, trauma-informed care, and resident safety, including abuse, neglect, and exploitation. Skilled nursing facility (SNF) leaders should be in the process of reviewing and updating their systems and processes to maintain compliance. To ensure SNFs are ready, this blog will cover a checklist of items facility leaders should review.

New guidance and revisions have impacted the following areas of Appendix PP of the State Operations Manual:

  • §483.10 (Resident Rights)
    • F557 (Respect, Dignity/Right to Have Personal Property)
    • F561 (Self-Determination)
    • F563 (Right to Receive/Deny Visitors)
    • F582 (Medicaid/Medicare Coverage/Liability Notice)
  • §483.12 (Freedom From Abuse, Neglect, and Exploitation)
    • F600 (Free From Abuse and Neglect)
    • F604 (Right to Be Free From Physical Restraints)
    • F607 (Develop/Implement Abuse/Neglect, etc. Policies)
    • F608 (Reporting of Reasonable Suspicion of a Crime)
    • F609 (Reporting of Alleged Violations)
  • §483.15 (Admission, Transfer, and Discharge Rights)
    • F622 (Transfer and Discharge Requirements)
    • F623 (Notice Requirements Before Transfer/Discharge)
    • F626 (Permitting Residents to Return to the Facility)
  • §483.24 (Quality of Life)
  • §483.25 (Quality of Care)
    • F686 (Treatment/Services to Prevent/Heal Pressure Ulcers)
    • F687 (Foot Care)
    • F689 (Free of Accident Hazards/Supervision/Devices)
    • F690 (Bowel/Bladder Incontinence, Catheter, Urinary Tract Infection (UTI))
    • F694 (Parenteral/IV Fluids)
    • F695 (Respiratory/Tracheostomy Care and Suctioning)
    • F697 (Pain Management)
    • F699 (Trauma-Informed Care)
    • F656 (Develop/Implement Comprehensive Care Plan)
    • F700 (Bedrails)
  • §483.30 (Physician Services)
  • §483.35 (Nursing Services)
    • F725 (Sufficient Nursing Staff)
    • F727 (RN 8 Hours/7 Days/Week, Full-Time Director of Nursing (DON))
    • F729 (Nurse Aide Registry Verification, Retraining)
    • F732 (Posted Nurse Staffing Information)
  • §483.40 (Behavioral Health Services)
    • F740 (Behavioral Health Services)
    • F741 (Sufficient/Competent Staff—Behavioral Health Needs)
  • §483.45 (Pharmacy Services)
    • F755 (Pharmacy Services/Procedures/Pharmacist/Records)
    • F757 (Drug Regimen Is Free From Unnecessary Drugs) and F758 (Free From Unnecessary Psychotropic Medications/PRN Use)
    • F758 (Free From Unnecessary Psychotropic Medications/PRN Use)
  • §483.60 (Food and Nutrition Services)
  • §483.70 (Administration)
    • F847 (Enter Into Binding Arbitration Agreements) and F848 (Select Arbitrator/Venue, Retention of Agreements)
    • F851 (Payroll-Based Journal)
  • §483.75 (Quality Assurance and Performance Improvement (QAPI))
    • F865 (QAPI Program/Plan, Disclosure/Good Faith Attempt)
    • F866 (QAPI/QAA Data Collection and Monitoring)
    • F867 (QAPI/QAA Improvement Activities)
    • F868 (QAA Committee)
  • §483.80 (Infection Control)
    • F880 (Infection Prevention and Control)
    • F881 (Antibiotic Stewardship Program)
    • F882 (Infection Preventionist Qualifications/Role)
  • §483.85 (Compliance and Ethics Program)
  • §483.90 (Physical Environment)
  • §483.95 (Training Requirements)

Training required for all staff (tracking of staff participation also required):

  • F940 (Training Requirements—General): Requires that facilities develop, implement, and maintain effective training programs for all new and existing staff (including contract workers and volunteers), as well as determine the amount and types of training necessary based on the facility assessment.
    • F941 (Communication Training)
    • F942 (Resident’s Rights Training)
    • F944 (QAPI Training)
    • F945 (Infection Control Training)
    • F946 (Compliance and Ethics Training)
    • F949 (Behavioral Health Training)

Training required for nurse aides:

  • F947 (Required Inservice Training for Nurse Aides)

For an in-depth review of the F-tags impacted by the new guidance under each of the above areas, review AAPACN’s article, “Appendix PP Revisions in the State Operations Manual: Breaking Down Key Changes.” This article also links to CMS training videos and slides. 

Also, stay abreast of the latest articles and alerts, and find more resources and education to assist with the October 24 changes by checking AAPACN’s October 2022 Survey Updates webpage.

Not an AAPACN member? Join now to receive access to the information and resources you need to prepare for the Oct. 24, 2022, survey changes.