F-Tag Renumbering: What Matters and What Doesn’t

By Caralyn Davis, Staff Writer - July 26, 2017

Effective Nov. 28, 2017, state surveyors will use an entirely new numbering system for F-tags. The Centers for Medicare & Medicaid Services (CMS) updated the F-tags to correspond with the new regulatory sections implemented through the roll-out of the Reform of Requirements for Long-term Care Facilities (aka Mega-Rule) updating the Medicare/Medicaid conditions of participation. “Learning the new F-tag numbering system will come with time, but memorizing the numbers shouldn’t be the priority for directors of nursing services (DNSs),” advises Amy Stewart, RN, DNS-MT, QCP-MT, RAC-MT, AADNS curriculum development specialist. “Instead, DNSs should focus on knowing what’s new.”

So what do DNSs need to understand first? Here are Stewart’s two key takeaways:

 

Pay attention to the tag splits

 

The current survey process has 176 available F-tags, according to Federal Regulatory Groups for Long-term Care Facilities (October 2013 version). Effective with the Phase 2 rollout this November, the new survey process will have 179 F-tags, and that number will increase to 190 F-tags when Phase 3 implements on Nov. 28, 2019, according to Federal Regulatory Groups for Long-term Care Facilities (July 2017 version).

 

On the surface, 179 F-tags instead of 176 F-tags for the Phase 2 rollout may not seem like a big deal. However, “given the restructuring of the regulation, some tags were combined, and some tags were split into multiple subparts,” notes CMS in survey-and-certification memo S&C: 17-36-NH.

 

The F-tag splits made by CMS are critically important, says Stewart. “For example, the current survey process has 27 F-tags in §483.10 (Resident Rights). In the new survey process, that section of the Code of Federal Regulations (CFR) will have 35 F-tags. Similarly, the current survey process has six F-tags in §483.13 (Resident Behavior and Facility Practices), while the comparable section in the new survey process, §483.12 (Freedom From Abuse, Neglect, and Exploitation), will have 10 F-tags.” (See Chart 1 at the end of this article for an overview of the section-by-section differences between the current and the new survey processes.)

 

This should matter to the DNS because these types of splits will create more opportunities for multiple citations, says Stewart. “For example, the current F-tag F225 (Investigate/Report Allegations/Individuals) in §483.13 will be replaced by three F-tags in §483.12: F608 (Reporting Reasonable Suspicion of a Crime), F609 (Reporting of Alleged Violations), and F610 (Investigate/Prevent/Correct Alleged Violations). So while multiple tags have always been possible in an abuse situation, the likelihood of landing multiple tags has increased significantly.”

 

Pay attention to the substandard quality-of-care tags

 

Tied into the splits, the number of F-tags where one or more deficiencies with scope-and-severity levels of F, H, I, J, K, or L equals substandard quality of care has increased, says Stewart. Currently, this applies to 44 F-tags: F221 – F226 in §483.13 (Resident Behavior and Facility Practices); F240 – F258 in §483.15 (Quality of Life); and F309 – F334 in §483.25 (Quality of Care).

 

In the new survey process, one or more deficiencies with scope-and-severity levels of F, H, I, J, K, or L in 49 F-tags addressing eight CFR sections will equal substandard quality of care. “For example, all 10 F-tags in the new §483.12 (Freedom From Abuse, Neglect, and Exploitation) will fall under the substandard quality-of-care designation,” says Stewart. (See Chart 2 at the end of this article for a breakout of all F-tags that will come into play for substandard quality of care in the new survey process.)

 

“CMS hasn’t yet released an advance copy of the revised Appendix P, ‘Survey Protocol for Long-term Care Facilities,’ in the State Operations Manual,” points out Stewart. However, according to the current version of this appendix, surveyors in both a standard traditional survey and a standard Quality Indicator Survey will conduct an extended survey if they determine that the facility provided substandard quality of care in any of the identified F-tags. So providers probably should expect similar requirements in the new survey process, she notes.

 

Note: Access the advance copy of Appendix PP, “Guidance to Surveyors for Long-term Care Facilities,” of the State Operations Manual here.

 

 

Chart 1

Overview of tag differences per regulatory section

Current survey – 176 total F-tags

New survey – 190 total F-tags by Phase 3 rollout

Definitions

1 tag (F150)

Definitions

1 tag (F540)

§483.10 (Resident Rights)

27 tags (F151 – F177)

§483.10 (Resident Rights)

35 tags (F550 – F586)

§483.13 (Resident Behavior and Facility Practices)

6 tags (F221 – F226)

§483.12 (Freedom From Abuse, Neglect, and Exploitation)

10 tags (F600 – F610)

§483.12 (Admission, Transfer, and Discharge)

8 tags (F201 – F208)

§483.15 (Admission, Transfer, and Discharge)

7 tags (F620 – F626)

§483.20 (Resident Assessment)

16 tags (F271 – F287)

§483.20 (Resident Assessments)

11 tags (F635 – F646)

NA as a separate section, some under Resident Assessment

§483.21 (Comprehensive Resident-Centered Care Plans)

7 tags (F655 – F661)

§483.15 (Quality of Life)

18 tags (F240 – F258)

§483.24 (Quality of Life)

6 tags (F675 – F680)

§483.25 (Quality of Care)

20 tags (F309 – F334)

§483.25 (Quality of Care)

17 tags (F684 – F700)

§483.40 (Physician Services)

6 tags (F385 – F390)

§483.30 (Physician Services)

6 tags (F710 – F715)

§483.30 (Nursing Services)

4 tags (F353 – F356)

§483.35 (Nursing Services)

8 tags (F725 – F732)

NA as a separate section, some under Quality of Care

§483.40 (Behavioral Health Services)

6 tags (F740 – F745)

§483.60 (Pharmacy Services)

3 tags (F425 – F431)

§483.45 (Pharmacy Services)

7 tags (F755 – F761)

NA as a separate section, some under Administration

§483.50 (Laboratory, Radiology, and Other Diagnostic Services)

10 tags (F770 – F779)

§483.55 (Dental Services)

2 tags (F406 – F407)

§483.55 (Dental Services)

2 tags (F790 – F791)

§483.35 (Dietary Services)

13 tags (F360 – F373)

§483.60 (Food and Nutrition Services)

15 tags (F800 – F814)

§483.45 (Specialized Rehabilitative Services)

2 tags (F406 – 407)

§483.65 (Specialized Rehabilitative Services)

2 tags (F825 – F826)

§483.75 (Administration)

34 tags (F490 – F524)

§483.70 (Administration)

15 tags (F835 – F851)

NA

§483.75 (Quality Assurance and Performance Improvement)

4 tags (F865 – F868)

§483.65 (Infection Control)

1 tag (F441)

§483.80 (Infection Control)

4 tags (F880 – F883)

NA

§483.85 (Compliance and Ethics Program)

1 tag (F895)

§483.70 (Physical Environment)

15 tags (F455 – F469)

§483.90 (Physical Environment)

21 tags (F906 – F926)

NA as a separate section, some under Administration and Dietary Services

§483.95 (Training Requirements)

10 tags (F940 – F949)

Sources: Compiled by AADNS from Federal Regulatory Groups for Long-term Care Facilities, October 2013 version and July 2017 version. For specifics about the new tags and which are Phase 3 rollouts, see the July 2017 version. Find a specific tag-to-tag crosswalk here.

 

 

 

Chart 2

Substandard quality of care = 1 or more deficiencies with scope-and-severity levels of F, H, I, J, K, or L in the new survey process

 

· §483.10 (Resident Rights):

o F550 (Resident Rights/Exercise of Rights);

o F558 (Reasonable Accommodations of Needs/Preferences);

o F559 (Choose/Be Notified of Room/Roommate Change);

o F561 (Self-Determination);

o F565 (Resident/Family Group and Response); and

o F584 (Safe/Clean/Comfortable/Homelike Environment).

· §483.12 (Freedom From Abuse, Neglect, and Exploitation):

o F600 (Free From Abuse and Neglect);

o F602 (Free From Misappropriation/Exploitation);

o F603 (Free From Involuntary Seclusion);

o F604 (Right to Be Free From Physical Restraints);

o F605 (Right to Be Free From Chemical Restraints);

o F606 (Not Employ/Engage Staff With Adverse Actions);

o F607 (Develop/Implement Abuse/Neglect, etc. Policies);

o F608 (Reporting of Reasonable Suspicion of a Crime);

o F609 (Reporting of Alleged Violations); and

o F610 (Investigate/Prevent/Correct Alleged Violation).

· §483.24 (Quality of Life):

o F675 (Quality of Life);

o F676 (Activities of Daily Living (ADLs)/Maintain Abilities);

o F677 (ADL Care Provided for Dependent Residents);

o F678 (CardioPulmonary Resuscitation (CPR));

o F679 (Activities Meet Interest/Needs of Each Resident); and

o F680 (Qualifications of Activity Professional).

· §483.25 (Quality of Care):

o F684 (Quality of Care);

o F685 (Treatment/Devices to Maintain Hearing/Vision);

o F686 (Treatment/Services to Prevent/Heal Pressure Ulcers);

o F687 (Foot Care)’

o F688 (Increase/Prevent Decrease in ROM/Mobility);

o F689 (Free of Accident Hazards/Supervision/Devices);

o F690 (Bowel/Bladder Incontinence, Catheter, UTI);

o F691 (Colostomy, Urostomy, OrIleostomy Care);

o F692 (Nutrition/Hydration Status Maintenance);

o F693 (Tube Feeding Management/Restore Eating Skills)

o F694 (Parenteral/IV Fluids);

o F695 (Respiratory/Tracheostomy Care and Suctioning);

o F696 (Prostheses);

o F697 (Pain Management);

o F698 (Dialysis);

o F699 (Trauma Informed Care) Note: This F-tag doesn’t implement until Phase 3 of Mega-Rule implementation; and

o F700 (Bed rails).

· §483.40 (Behavioral Health Services):

o F742 (Treatment/Svc for Mental/Psychosocial Concerns);

o F743 (No Pattern of Behavioral Difficulties Unless Unavoidable);

o F744 (Treatment/Service for Dementia); and

o F745 (Provision of Medically Related Social Services).

· §483.45 (Pharmacy Services):

o F757 (Drug Regimen is Free From Unnecessary Drugs);

o F758 (Free From Unnecessary Psychotropic Meds/PRN Use);

o F759 (Free of Medication Error Rates of 5% or More); and

o F760 (Residents Are Free of Significant Med Errors).

· §483.70 (Administration):

o F850 (Qualifications of Social Worker >120 Beds).

· §483.80 (Infection Control):

o F883 (Influenza and Pneumococcal Immunizations).

 

Source: Compiled by AADNS from Federal Regulatory Groups for Long-term Care Facilities, October 2013 version.

 


For permission to use or reproduce this article in full or in part, please submit a permissions form


Comments:
Add New Comment
Name*:  
Email*:  
Website:
Title*:  
Comment*: