CMS Makes Major Survey Announcement at Inaugural AADNS Conference

By Jessica Kunkler, MA - October 12, 2016

At the inaugural AADNS Conference in Baltimore, CMS representatives spoke about the Final Rule, released just hours before their conference session.

The Final Rule, posted in the Federal Register on October 4, is effective November 28, 2016, and will be implemented in three phases over the next three years. The rule emphasizes person-centered care, a systems-level approach to quality, and the Department of Health and Human Services’ initiatives to reduce unnecessary hospital admissions and incidences of healthcare-associated infections. It also seeks to improve behavioral healthcare and safeguard nursing facility residents from the use of unnecessary antipsychotic medications. Lastly, the rule introduces a competency-based approach to facility assessments (including self-assessments) and implements legislation.

The three-phase implementation is outlined below:

  • Phase 1: Existing requirements, those requirements relatively straightforward to implement, and requirements for minor changes to survey process (Implementation Date: November 28, 16)
  • Phase 2: All Phase 1 requirements, and those that providers need more time to develop, foundational elements, included in new survey (Implementation Date: November 28, 17)
  • Phase 3: All Phase 1 and 2, and those requirements that need more time to implement (e.g., personnel hiring and training, implementation of systems approaches to quality) (Implementation Date: November 28, 19)

What seemed to get the most attention in the CMS talk, however, was the announcement of a new survey process and enforcement protocol that combines the Quality Indicator Survey (QIS) and the Traditional Survey, making for a standard nationwide survey.

Survey Process Overhaul

The new survey process was designed by taking the positives from each existing survey process and ironing out the consistency and efficiency issues that exist with each. The new survey process will have both a sample selection component (implemented both off-site and on-site) and an investigative process, including interviews, observations, and record reviews. The new survey process will be rolled out in two phases. Phase 1 will be effective November 28, 2016, at which time new regulatory language under the current F-Tags will be effective. Phase 2 will be effective November 28, 2017, and will include a new Appendix PP to the State Operations Manual (with new F-Tag numbers and Interpretive Guidance changes) and implementation of the new survey process.

Survey Enforcement Updates

Major changes to survey enforcement protocol include the immediate imposition of federal remedies in the case of immediate jeopardy (IJ) and deficiencies of substandard quality of care (SQC), including any G-level deficiency in SQC regulatory groupings, Double G+ deficiencies, or F deficiencies, without permitting the facility an opportunity for correction (S&C 16-31-NH). Additionally, a facility with a deficiency at the F level will become a Special Focus Facility (SFF). These changes are effective for all surveys completed on or after September 1, 2016.


The conditions of participation for long-term care have not been updated comprehensively since 1991, even though the landscape of long-term care has changed significantly over the past 25 years. The changes issued by the Final Rule, inclusive of the survey process overhaul, seek to more effectively measure and improve the quality of care, although they are sure to cause a few headaches as facilities adopt and comply. But, remember that AADNS will be with you along the way to help you navigate the changes.


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