Updated Federal Guidance

CMS updated federal guidance for nursing homes. The updates had been due since 2019, but were delayed by the agency for additional review prior to the pandemic. To support the Long-Term Care (LTC) Facilities Requirements for Participation, CMS  issued surveyor guidance. The guidance clarifies requirements and compliance. CMS is highlighting the benefits of reducing the number of residents in each room given the lessons learned during the COVID-19 pandemic for preventing infections and the importance of residents’ rights to privacy and homelike environment.

In addition, CMS strengthened the management of complaints and facility reported incidents. The updated guidance will go into effect on Oct. 24, 2022.

Summary of Significant Changes

Abuse and Neglect

Clarifies compliance, abuse reporting, including sample reporting templates, and provides examples of abuse that, because of the action itself, would be assigned to certain severity levels.

Mental Health/Substance Use Disorder (SUD):

Addresses rights and behavioral health services for individuals with mental health needs and SUDs.

Nurse Staffing (Payroll-Based Journal):

Uses payroll-based staffing data to trigger deeper investigations of sufficient staffing and added examples of noncompliance. “This will help better identify potential noncompliance with CMS’s nurse staffing requirements, such as lack of a registered nurse for eight hours each day, or lack of licensed nursing for 24 hours a day,” the agency said in a statement. “This guidance will help to uncover instances of insufficient staffing and yield higher quality care.”

Potential Inaccurate Diagnosis and/or Assessment

Addresses situations where practitioners or facilities may have inaccurately diagnosed/coded a resident with schizophrenia in the resident assessment instrument.


Addresses unnecessary use of non-psychotropic drugs in addition to antipsychotics, and gradual dose reduction.

Infection Control:

Requires facilities have a part-time Infection Preventionist. While the requirement is to have at least a part-time IP, the IP must meet the needs of the facility. The IP must physically work onsite and cannot be an off-site consultant or work at a separate location.

Psychosocial Outcome Severity Guide

Clarifies the application of the “reasonable person concept” and severity levels for deficiencies.

State Operations Manual Chapter 5

Clarifies timeliness of state investigations, and communication to complainants to improve consistency across state