CMS Releases Revised Guidance for the LTC Facility Assessment

Today, the Centers for Medicare and Medicaid Services (CMS) released the revised guidance for the Long-term Care Facility Assessment regulation (QSO-24-13-NH), as part of the federal staffing mandate finalized last month.

The revised regulatory requirements have been moved from 42 CFR 483.70 to 42 CFR 483.71.  Existing regulations at 42 CFR 483.70(f) through (q) have been redesignated as paragraphs (e) through (p), respectively. The revised guidance notes that surveyors should determine whether a facility assessment contains the required components under the regulation; they should not evaluate the quality of the assessment.
The revision to the facility assessment regulation at F838 takes effect and must be implemented by August 8, 2024.
Areas added to the guidance to determine compliance include but are not limited to the following:
  • The facility assessment includes an evaluation of the resident population, and its needs (e.g., acuity) based on evidence-based, data driven methods.
  • The facility assessment reflects the population.
  • The facility assessment addresses the facility’s resident capacity.
  • The facility assessment includes information on the staffing level(s) needed for specific shifts, such as day, evening, and night and adjusted as necessary based on changes to resident population.
  • The facility assessment addresses what skills and competencies are required by those providing care.
  • The facility assessment is conducted with input from the individuals stated in the regulation (483.71(b))
  • The facility assessment indicates what resources, including but not limited to, equipment, supplies, services, personnel, health information technology, and physical environment are required to meet all resident needs.
  • The facility has a plan for maximizing recruitment and retention of direct care staff.
  • The facility assessment includes a contingency plan that is informed by the facility assessment.
AHCA is reviewing the guidance and will share helpful resources soon. Please reach out to​ with any questions.

Survey Tip: Documenting Protection on Abuse Reporting

A new survey tip has been posted to the AHCA Survey Regulatory page for your review. In the new Survey Tip section, on the Survey Regulatory page, you will find tips related to recently noted survey trends. In the latest survey tip, you will find tips to ensure you are protecting resident(s) from further abuse, and sufficiently documenting the protection you have provided/are providing residents on both your initial abuse reporting and your 5-day working report to the State Survey Agency.
For additional information about abuse, neglect, and misappropriation of resident property, please review the webinar series on ahcancalED. The series also provides individual tip sheets for each F-tag associated with abuse. If you have any topics or suggestions for future survey tips, or survey/regulatory questions, please send them to​.

Navigating “Safety” in Long Term Care Centers: Separating the Roles of OSHA and the CMS requirements for Emergency Preparedness


In this third article regarding the connection between the Occupational Safety and Health Administration (OSHA) and the Centers for Medicare & Medicaid Services (CMS) Life Safety and Emergency Preparedness (EP) Requirements, the focus will be on how OSHA’s regulations overlap with CMS’ EP requirements, found in 42 CFR 483.73 (Appendix Z).
It’s important to note that CMS’ EP requirements do NOT apply to assisted living, however any OSHA requirements do apply.

Deadline Approaching to Submit Comments on Proposed Minimum Staffing Rule

​The formal comment period on the CMS minimum staffing proposed rule is nearing an end. Though AHCA/NCAL met its original goal of submitting 10,000 comments to CMS from members during the 60-day comment period, a new goal has been set to reach 15,000 comments to have a greater impact with CMS and the Administration.
With just under two weeks until the end of the comment period, this is a great opportunity to share with CMS why this rule won’t work. Submitting a comment is easy! Just visit our Action Center, where there are details on what to write in the comments, including specific asks for CMS regarding the rule. Comments are due November 6. Assisted living providers are encouraged to submit comments, as well.
For information on the effects of the minimum staffing proposed rule on skilled nursing, view our Issue Brief. For details on the impact of the minimum staffing proposed rule on assisted living, view our NCAL Issue Brief.
For additional information or questions, please contact Matt Smyth or Heather Posthumus​.

Proposed Minimum staffing requirements for SNFs from CMS – What You Need to Know!

Thanks to one of our alert Gero Nurse Prep students for reminding us of the importance of this pending regulation.

To get the Fast Facts on the implications of  this unfunded mandate, go here:

AHCA/NCAL has set a goal of submitting more than 10,000 comments on this proposed rule between now and November 6th. To make your voice heard, go to: []

CMS Creates a SNF 5-Claim Probe and Educate Review Webpage

The Centers for Medicare & Medicaid Services (CMS) recently announced the start of the SNF (skilled nursing facility) 5-Claim Probe & Educate Review program. As part of the effort to lower the SNF improper payment rate, Medicare Administrative Contractors (MACs) will be reviewing a small number of claims from every Medicare-billing SNF in the country. The SNF will then be offered education to address any errors identified, helping them to avoid future claim denials and adjustments.

Find out more by going to

CMS Releases Revisions to the Special Focus Facility Program

The Centers for Medicare & Medicaid Services (CMS) has released a revised Special Focus Facility (SFF) Program policy memo QS0-23-01-NH and updated the monthly SFF posting​. These revisions are meant to increase the requirements for completion of the program and enforcement for facilities that do not demonstrate improvement.


CMS Adds Staffing Measures to Five Star Rating System

The Centers for Medicare and Medicaid Services (CMS) posted QSO memo 22-08-NH last week indicating that it will begin posting staffing turnover and weekend staffing levels for each nursing home on the Care Compare website​ in January and add the measures to staffing domain of Five Star Rating system in July 2022.
  • Weekend Staffing: The level of total nurse (RN, LPN & CNA) and registered nurse (RN) staffing on weekends provided by each nursing home over a quarter.  This will be reported as average hours worked per resident per day on weekends.
  • Staff Turnover:
    • ​The percent of RN staff that left the facility over the last year.
    • The percent of total nurse staff that have left the facility over the last year.
    • The number of administrators that have left the facility over the last year.
The technical specifications for weekend staffing and staff turnover measures will be included in the Five Star Rating System Technical Users’ Guide on January 14, 2022.

Find out more at