CMS 2025 Revision: Comprehensive Update to Long Term Care Surveyor Guidelines

On November 18, 2024, CMS announced its intention to revise LTC Surveyor Guidance. The changes will focus on different areas ranging from administrative agreements and medication management to infection control and health equity considerations.

The guidance will be available to surveyors on February 24, 2025.

Here is a summary of notable changes in the new Surveyor Guidance:

F641

One important change relates to citations in F641 for the accuracy of assessment, whereby surveyors are instructed to review minimum data set (MDS) coding accuracy, but not investigate possible falsification of the MDS. The guidance requires surveyors to refer to OIG any three or more inaccurate MDS coding for residents as possible falsification.

Admission, Transfer, and Discharge

There are a few significant changes under this heading. To prevent financial coercion, under the new guidance facilities may no longer include language in their admission agreements that requests or requires a third-party guarantee of payment.

CMS is also removing several outdated tags, including F622 through F626 and F660 through F661, which previously dealt with facility-initiated and resident-initiated transfers and discharges. Two new citations will take the place of these removed tags. The revisions aim to make it easier for surveyors to identify instances of noncompliance, especially those related to transfers or discharges which violate patients’ rights.

Chemical Restraints/Unnecessary Psychotropic Medication

Regulation concerning the unnecessary use of psychotropic medications is located under F758 tag. The new guidance now incorporates the regulations under F605 to simplify the survey process and increase consistency in enforcement. Tag F757, addressing unnecessary medications, has also been changed to only include guidance for non-psychotropic medications.

The change highlights the need for facilities to prevent the unnecessary administration of psychotropic drugs to patients, especially when used for the convenience of staff.

The guidance further requires that patients should be notified of their rights to participate in their treatments and their rights to refuse or accept medication.

Infection Control

The new guidance incorporates enhanced precautions for preventing the spread of multi-resistant organisms (MDROs).

COVID-19 Update

CMS integrated updated COVID-19 immunization guidance into the survey process. Facilities will be required to offer all residents and staff COVID-19 vaccinations as part of an ongoing infection control effort, provide education about the benefits and risks of COVID-19 shots, and document any refusal or contraindication.

QAPI Health Equity Measures

The guidance will require facilities to collect data on factors that affect health equity, such as race, socioeconomic status, and language, and that this data is used to inform the facility's priorities and improvement efforts.

Facilities Medical Director Responsibilities

The guidance clarifies the responsibility of the facility's medical director, under tag F841. The facility medical director is now responsible for overseeing the implementation of and compliance with the resident care policies.

‍