CMS memo release—Guidance for federal monitoring surveys for nursing facilities
By Patti Cullen, CAE | November 22, 2023 | SNF/NF providers
On November 20, 2023, the Centers for Medicare & Medicaid Services (CMS) issued QSO 24-05-NH, “
Guidance for Federal Monitoring Surveys.” This QSO includes the updated areas identified for a federal focus concern survey as well as the estimated number of federal monitoring surveys for each state. The following are excerpts from the memo:
Background:
Long Term Care (LTC) Federal Monitoring Surveys (FMS) -- referred to in the statute as “validation surveys” -- must be performed by each CMS Location during each fiscal year (FY) to meet the statutory requirement of Section 1819(g)(3)(B) of the Social Security Act, which requires FMS of “…at least 5 percent of the number of skilled nursing facilities surveyed by the State in the year, but in no case less than 5 skilled nursing facilities in the State. LTC FMS include the health, Life Safety Code (LSC), and emergency preparedness (EP) parts of the survey.
LTC Health FMS
LTC Health FMS are comprised of three survey processes aimed at advising and evaluating State Agency (SA) Surveyors. An EP FMS is not conducted during Health FMS.
- Resource and Support Surveys (RSS) are surveys where the Federal Surveyor(s) accompany SA Surveyors on an initial, standard, revisit or complaint survey to observe and assess overall SA Surveyor team performance and performance related to specific areas of concern. The Federal Surveyor(s) may provide training and/or technical assistance to address identified performance needs while on-site or because of the evaluation of outcomes.
- Focused Concern Surveys (FCS) are one of the evaluative components of the FMS process. FCS are completed by one or more Federal Surveyor(s) conducting an independent investigation of the identified concern areas. FCS occur within 60 calendar days after a SA standard or complaint survey. The Federal Surveyor follows all investigative protocols and pathways for the concern areas to assess the effectiveness of SA performance.
- A Health Comparative is a full survey conducted by Federal Surveyors in the same facility, after a standard survey is conducted by the SA. The purpose of a Health comparative survey is to monitor and evaluate SA performance. A LTC Health comparative should be conducted within 60 calendar days following the SA’s standard survey.
Discussion of Health RSS and FCS
For FY24 and FY25, CMS has identified three LTC Health National Concern Areas. In addition to evaluating the three LTC Health National Concern Areas, CMS Locations may identify additional concern areas for States within their jurisdiction. One or more optional concern areas may be identified during the survey at the discretion of the Federal Surveyor. The three required LTC Health FMS concerns and the associated F-Tags, Regulatory Groupings, and Critical Element Pathways, are outlined in the table below:
CMS must complete the total mandated number of surveys in each state. 20% of the mandated surveys must be Comparatives, and 80% of the total mandated surveys are one of the two types of Federal Oversight Support Surveys (FOSS): RSS (Resource and Supports Surveys) or FCS (Focused Concern Survey). The targeted breakdown of FOSS each is roughly 50% of each type. For example, State A requires 46 total FMS. 10 of these must be comparatives and 36 are FOSS Type with a target of 18 FCS and 18 RSS accounting for the total of 36 FOSS.
Here are Minnesota’s numbers for FY 2024 and FY 2025: 18 total mandated surveys, 14 of which must be Federal Oversight Support Surveys—seven each of FCS and RSS.
Patti Cullen, CAE | President/CEO |
pcullen@careproviders.org | 952-851-2487