This is another article in a series discussing the complete overhaul of Part 483 to Title 42 of the Code of Federal Regulations, the Requirements for States and Long-Term Care Facilities (“Final Regulations”) by the Centers for Medicare & Medicaid Services (“CMS”).

BACKGROUND

On September 28, 2016, CMS released a complete overhaul of Part 483 to Title 42 of the Code of Federal Regulations, the Requirements for States and Long-Term Care Facilities. CMS’s Final Regulations cover many regulatory requirements for long-term care facilities and create new compliance obligations for providers. The Final Regulations seek to target rehospitalizations, facility-acquired infections, overall quality and resident safety.

Hall Render published an overview of Final Regulations components as well as Parts 1, 2, 3 and 4 in the series, which are located here, here, here and here.

IMPLEMENTATION IN PHASES

The Final Regulations became effective November 28, 2016. They were to be implemented in phases with the first phase-in period completed by November 28, 2016, followed by additional phases that end on November 28, 2017 and November 28, 2019. The implementation date for Phase 2 of the revisions is November 28, 2017.

CMS ISSUES GUIDANCE ON ENFORCEMENT OF PENALTIES

On June 30, 2017, the Survey and Certification Group at CMS issued a memorandum, “Revision to State Operations Manual (SOM) Appendix PP for Phase 2, F-Tag Revisions, and Related Issues” (“S&C Memo”) on enforcement of Phase 2 requirements. CMS will provide a one-year restriction of enforcement remedies for specific Phase 2 requirements. CMS wrote that it “will not utilize civil money penalties, denial of payment, and/or termination.” Should a facility be found to be out of compliance with these new requirements beginning in November of 2017, CMS would use this year-long period to educate facilities about certain new Phase 2 quality standards by requiring a directed plan of correction or additional directed in-service training. CMS emphasized that this one-year period is not a change in the required implementation date for Phase 2 provisions.

Enforcement for other existing standards, including Phase 1 requirements, will follow the standard process.

REVISED F-TAGS

The Final Regulations caused many of the previous regulatory citations to be re-designated. CMS re-numbered the F-Tags used to identify each regulatory part. CMS created a list of the F-Tags under each regulatory group and a F-Tag crosswalk that compares the prior F-Tags to the new F-Tags. The re-structuring of the regulation caused some tags to be combined while others were split into multiple subparts.

PRACTICAL TAKEAWAYS

CMS will provide a one-year restriction of enforcement remedies for specific Phase 2 requirements. The one-year delay does not alter the Phase 2 implementation date of Nov. 28, 2017. The delay only impacts the monetary penalties. Many F-Tags were renumbered. CMS has created a crosswalk reference guide for old and new F-Tags.

A link to the S&C Memo is here.