CMS Delays SNF Penalties for Phase 2

a nurse laughing and talking with a senior patient in a wheelchair

On June 30, the Center for Clinical Standards and Quality/Survey & Certification Group issued a memorandum outlining revisions to the State Operations Manual (SOM) Appendix PP for Phase 2, F-Tag revisions, and several other related issues specific to the Requirements of Participation of nursing centers. The new CMS mandates include the minimum health and safety standards that skilled nursing facilities must meet to participate in Medicare and Medicaid.

The revised Requirements of Participation (RoP) for skilled nursing facilities were released on Sept. 28, 2016, with the first phase becoming effective on Nov. 28 of last year. Phase 2 and 3 will come into effect on Nov. 28 of this year and on Nov. 28, 2018, respectively.

CMS informed providers that skilled nursing facilities will not be subject to enforcement penalties related to the implementation of certain requirements of Phase 2 of the Requirements of Participation. This announcement provokes a sigh of relief from providers, giving them a year to feel confident implementing these new requirements while learning how the new survey process will work. It will also give surveyors a chance to better understand how these new requirements have been operationalized by the various skilled nursing centers.  

CMS understands that the skilled nursing provider concerns stemmed from the amount of increased time needed to make certain that they met the new requirements without the added threat of an enforcement action.

The Enforcement section of the memorandum states, “CMS will provide a one- year restriction of enforcement remedies for specific Phase 2 requirements. Specifically, we will not utilize civil money penalties, denial of payment, and/or termination. Should a facility be found to be out of compliance with these new requirements beginning in November of 2017, CMS would use this year-long period to educate facilities about certain new Phase 2 quality standards by requiring a directed plan of correction or additional directed in-service training.”

According to CMS, the listing of specific Phase 2 requirements associated with enforcement delays will be shared at a later date. In general, CMS will identify those requirements that are associated with a unique and separate tag and where specialized efforts and technical assistance may be needed (e.g., antibiotic stewardship, facility assessment, Quality Assurance and Performance Improvement plan). Stay tuned for more details from CMS.

However, CMS was clear that enforcement for Phase 1 requirements will follow the standard timeline and process as previously outlined.  

SNF Resource Updates

The Survey and Certification Memorandum also provided some additional resources to nursing home providers. Additional resources included a revised list of F-Tags by regulatory category as well as a crosswalk from old F-Tags to new F-Tags.  These resources were attached to the Survey and Certification Memorandum.

In addition, CMS will be providing training resources to providers.  These resources include:

  • Medicare Learning Network (MLN) Call
    • This call took place on July 25th, but the presentation slides can be found on their website.  An audio recording should be available in the very near future and will be available on their site as well.
  • An updated slide deck outlining the new survey process
  • Training Videos
    • Eleven key topics for the new Interpretive Guidelines.
    • Provider-specific training focused on the elements most needed by the providers to prepare for the new survey (e.g., materials to be requested upon entrance conference).

In the same communication, CMS said it would also keep the Nursing Home Five Star Quality Rating system health inspection score for any facility in place for one year for surveys conducted after Nov. 28.

The memorandum states, “However, due to the differing standards being phased in over the year, CMS will be holding constant for one year the Nursing Home Compare health inspection rating for any surveys conducted after November 28, 2017. CMS has done this previously where the star ratings are maintained for a period of time as new requirements are phased-in. To address the concern that serious quality concerns will not be known, CMS will separately flag those nursing facilities to ensure public transparency. CMS will provide more detailed methodology information at a later date.”


Our team will be monitoring to see what new methodology CMS will use to identify “problem” centers and exactly which Phase 2 requirements will benefit from the one year delay in enforcement.  I believe I can speak for all providers and say that everyone is grateful for the opportunity to adjust to the new requirements and the new survey process without the concern of enforcement.

It is going to be a very interesting and busy year for everyone, providers and surveyors alike. What are your thoughts? We’d love to hear – please comment below!


Written by Donna Thiel, Chief Compliance Officer

Donna Thiel is the Director of our Compliance Integrity team, a consulting division of ProviderTrust. Donna works with compliance officers across the country to help reduce the stress and anxiety of this very difficult role.
Connect with Donna on LinkedIn

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