CFR Surveyor Interpretive Guidance for Long-term Care Facilities (NFs and SNFs), Appendix PP, State Operations Manual (SOM)
Appendix PP, “Guidance to Surveyors for Long-term Care Facilities,” contains the relevant sections of the Code of Federal Regulations (42 CFR 483), the corresponding F-tags (
F540 - F5949), and the interpretive guidelines that surveyors are expected to use in assessing nursing facility compliance with the Medicare/Medicaid conditions of participation. The current Appendix PP is effective as of Nov. 28, 2017. Its implementation corresponds with the nationwide implementation of the new survey process, including a new F-tag numbering system and the Phase 2 rollout of the revised Medicare/Medicaid conditions of participation (aka the reform of requirements). These instructions cover the full range of operational, physical plant, and quality issues that surveyors assess. For example, there are sections on:
Resident rights, including but not limited to telephone, mail, personal property, and discharge rights;
Freedom from abuse, neglect, and exploitation, including but not limited to restraints and staff treatment of residents;
Quality of life, including but not limited to activities of daily living, activities, and CPR;
Resident assessments, including but not limited to admission orders, comprehensive assessment, coordination, assessment accuracy, and significant change notifications;
Quality of care, including but not limited to nutrition, hydration, bowel/bladder incontinence, and pain management;
Nursing services, including but not limited to sufficient staff, competent staff, and registered nurses;
Food and nutrition services, including but not limited to staffing, therapeutic diets, assistive devices, and paid feeding assistants;
Physician services, including but not limited to physician supervision, physician visits, and physician delegation of tasks in SNFs;
Specialized rehabilitative services;
Dental services;
Pharmacy services, including but not limited to drug regimen review;
Infection control, including but not limited to linens;
Physical environment, including but not limited to emergency power and the resident call system; and
Administration, including but not limited to licensure, Payroll-Based Journal, medical director requirements, and the facility assessment.
Access a crosswalk between the old and new F-tags
here. Access the new survey process entrance conference worksheet and provider matrix here. Access the new survey tools, including Critical Element Pathways and Facility Task Pathways,
here
.