CMS Delays Enforcement of Smoking Rules, Other Phase 2 Requirements

Skilled nursing operators can breathe a little easier as the second phase of the new Requirements for Participation takes effect this week: The Centers for Medicare & Medicaid Services (CMS) has delayed penalties for several of the new requirements.

For the next 18 months, CMS won’t take enforcement action — in the form of civil money penalties, payment denials for new admissions, or discretionary termination — over eight specific F-Tags included in the survey process, as listed below:

  • F655 Baseline Care Plan
F740 Behavioral Health Services
F741 Sufficient/Competent Direct Care/Access Staff-Behavioral Health
  • F758 Psychotropic Medications
  • F838 Facility Assessment
  • F881 Antibiotic Stewardship Program
  • F865 QAPI Program and Plan
  • F926 Smoking Policies

Some of those requirements could be challenging for skilled nursing providers to implement — including the smoking requirement, which would task SNF operators with listing all smokers in the building and furnish surveyors with detailed information about the site’s tobacco policy and hours.


“CMS will use this 18-month moratorium period to educate surveyors and the providers to ensure they understand the health and safety expectations that will be evaluated through the survey process, since these Phase 2 requirements are associated with unique and separate tags where specialized efforts and technical assistance may be needed,” the agency said.

The changes officially took effect Tuesday, with the third and final round of Requirements of Participation rules scheduled for November 2018.

CMS emphasized that surveyors should continue to cite these new tags in their reports even during the moratorium period. In addition, the agency specifically cited that F608, which provides guidelines on reporting suspected crimes, will be enforced “due to the concerns about significant resident abuse going unreported.”


A recent study from the Department of Health and Human Services’ Office of the Inspector General (OIG) found a significant amount of unreported abuse and neglect incidents at nursing homes, and the OIG pointed a finger at CMS.

“We determined that CMS procedures are not adequate to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported,” the OIG report stated.

Five-Star Changes

Due to the changing survey process, CMS also announced that it will freeze the health inspection portion of the Five-Star Quality Rating System for approximately one year starting in early 2018.

The agency will also now use only the two most recent health inspections and complaint data when calculating the star ratings, as opposed to three.

Read the full memo on the CMS website.

Written by Alex Spanko

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