Long Term Care Survey Process Cynthia Vargo CoManager

Long Term Care Survey Process Cynthia Vargo, Co-Manager Nursing Facility Survey Unit APD Safety, Oversight & Quality 9/07/17 1

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Presentation Outline • • Regulation Reform F-tag Re-numbering Long Term Care Survey Process (LTCSP) Preparations 4

Regulation Reform 5

Regulation Reform Development Sources • • QIS/Traditional Processes State Survey Agencies Regional Offices CMS Central Office University of Colorado Technical Expert Panel Literature Review & Data Analyses 6

Regulation Reform Overview effective November 28, 2016 Legislation revisions include: • Affordable Care Act (ACA), and • Improving Medicare Post-Acute Care Transformation (IMPACT) Act – – – Quality Assurance and Performance Improvement (QAPI); Reporting suspicion of a crime; Increased discharge planning; Staff training section; and Nursing facility requirements for participation. 7

Regulation Reform Implementation Grid Implementation Date Type of Change Details of Change Phase 1: November 28, 2016 LTC Requirements for Participation Changes to current F-tag Regulatory Language Phase 2: November 28, 2017 F-tag re-numbering Interpretive Guidance (IG) LTC Survey Process (LTCSP) New F-tags New Interpretive Guidelines New LTCSP begins Phase 3: November 28, 2019 More LTC Requirements that need more time to implement 8

Phase 2 of LTC Regulations • • Effective November 28, 2017 Providers must be in compliance with Phase 2 regulations All States use new LTCSP for surveys Trainings completed before implementation date 9

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F-Tag Renumbering 11

F-tag Renumbering 12

F-tag Renumbering Crosswalk provides original and associated new: – Regulatory grouping; – Regulation number; and – F-tag 13

CMS release Fall 2017 • • F-tag re-numbering F-tag crosswalk Regulation appendices P and PP Interpretive Guidance updates (Surveyors will use the most recent version) 14

Long Term Care Survey Process 15

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Why change the Survey Process? • Improve efficiency and effectiveness; • Combine: – Quality of care/quality of life areas; – Traditional and QIS survey processes; – Best of both into one nationwide survey process. 17

New LTCSP Goals • • • Same survey process entire country Retain strengths from each process New innovative approaches Effective and efficient Resident-centered Balance between structure and surveyor autonomy 18

Automation Quality Indicator Survey (QIS) New LTCSP • Surveyor uses tablet PC; • Findings synthesized and organized; • QIS software • LTCSP software 19

Resident Sample Selection QIS New LTCSP Random resident selection for: • Admission sample (up to 30 current or discharged records); • Sample size determined by facility census; • Census sample (up to 40 current resident observations, interviews and record reviews); • Approximate selection: o 70% MDS pre-selected; o 30% surveyor-selected; • Complaints can be included in census sample • Maximum sample size 35; • Maximum complaint sample 5 20

Entrance Information Needed QIS New LTCSP • Facility census number; • Alphabetical list of residents; • New admissions last 30 days • New admission Matrix last 30 days; • List of residents who smoke 21

Updated Facility Matrix (Draft) Residents Admitted within Past 30 days New fiers! i t n Ide 22

Initial Entry to Facility QIS • No sample selection (random only); New LTCSP • No initial tour process; • Initial tour of facility, resident population and • Full observation/interview of all residents; staff/resident interactions; • Limited record review for initial pool • 30– 45 minutes average initial tour; process: • Offsite selected residents • Dining & kitchen review • New admissions • Vulnerable residents • Other identified concerns • 8 hours average initial pool process; • Dining & kitchen review 23

Survey Structure QIS New LTCSP • Stage 1: Preliminary investigation of • Resident sample about 20% of current regulatory areas in the admission and census; samples and mandatory facility tasks started; • Initial pool observation, interview and • Stage 2: Completion of in-depth limited record reviews; investigation of triggered care areas and/or facility tasks based on Stage 1 identified • Surveyors select up to 50% sample; concerns • Investigations continue for each sampled resident; • Facility tasks and closed record reviews completed 24

Group Interviews QIS New LTCSP • Interview Resident Council President or Representative; • Resident Council Meeting with active members; • Resident Council minutes review 25

Facility Tasks QIS • • Dining; Infection Control; Beneficiary Notification; Kitchen; Medication Administration; Medication Storage; Resident Council; QAA/QAPI New LTCSP • • • Dining; Infection Control; Beneficiary Notification; Kitchen; Medication Administration; Medication Storage; Resident Council; QAA/QAPI; Nurse Staffing 26

Preparations 27

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State Agency Preparations • August 2017 – State survey train the trainers • September 2017 – State surveyor webinar trainings • November 2017 – LTCSP Phase 2 National Implementation – Phase 2 of LTC regulations required for implementation • January 2018 – New CMS training material for LTC 29

Training Layers CMS and State Agency 30

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Provider and Public Preparations • • • CMS National Calls and Q&As – Fall 2017 Surveyor Training Materials Interpretive Guidance Videos Survey Forms and Critical Element Pathways Integrated Surveyor Training Website (ISTW) 32

Integrated Surveyor Training Website (ISTW) • https: //surveyortraining. cms. hhs. gov – Web-based training – Video webcasts – Archived webinars – Surveyor training videos More CMS online training platforms. . . 33

https: //surveyortraining. cms. hhs. gov 34

ISTW – Currently two Provider specific trainings 35

ISTW filter by: Long Term Care 36

ISTW: Surveyor Training Videos Filter: LTC>search course>SME 37

Subject Matter Expert (SME) videos: • • • Admission, Transfer and Discharge Appendix PP Overview of Revised Interpretive Guidance Behavioral Health Facility Assessment Freedom form Abuse, Neglect and Exploitation Infection Control Person Centered Care Pharmacy Services Quality Assurance and Process Improvement Plan – The Basics Quality of Life and Quality of Care Nursing Services 38

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Questions? 40