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Part III Standards for Compliance

performance (ie, 5% of total facilities per state with a minimum of five surveys). There are two types of FMS under the standard survey process:

1. The Federal Oversight Support Survey (FOSS), which is conducted at the same time as the state agency survey

2. The Comparative Survey (look-behind survey), which is conducted by the CMS Regional Office (RO) or by designated contractors under the authority of CMS (Central Office or the RO) within two months of the state agency exit

In those states that are utilizing the QIS process (further information is provided on this survey process later in the chapter), the federal surveys are called Comparative Survey or a Federal Oversight of a Quality Indicator Survey (FOQIS). The purpose of the Comparative Survey is to “assess the State Agency (SA) performance in the interpretation, application, and enforcement of Federal LTC require- ments and evaluate facility compliance with Medicare and Medicaid requirements” (10). The Comparative Surveys will take place no sooner than 10 working days after the SA exited but no later than 30 days from the exit. The FOQIS takes place at the same time as the SA’s survey. “During the FOQIS, the Regional Office (RO) evaluator will complete a structured and objective process to monitor a SA team’s ability to evaluate a long-term care facility for compliance with CFR 42 Section 483 subpart B requirements. The intent of the FOQIS is to promote the highest attainable quality of care and services for the residents of long-term care facilities” (6,10).

The Standard Survey

The standard survey process is described in the SOM, Appendix P. The process is outlined for both the tradi- tional survey and QIS. The most recent revision to this section is on the CMS website. “CMS deems both as surveys of record to evaluate compliance of nursing homes with the requirements at 42 CFR 483.5-483.75” (5):

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The traditional survey, which uses Forms CMS- 670, CMS-671, CMS-672, CMS-677, and CMS-801 through CMS-807

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The QIS, which uses the QIS procedures and forms as contained in the QIS Surveyor Training Manual. CMS maintains the authority to identify those states that are permitted to use the QIS. Only CMS-approved training entities and training materials may be used by states to train their surveyors in the QIS. The QIS is used by a

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State Survey Agency only upon approval by CMS.

CMS is in the process of a staged implementation of the QIS as a replacement for the current (traditional) survey process. The QIS is a two-staged, computer- assisted survey process with Stage 1 consisting of com- puter analysis of off-site data as well as data collected by surveyors on site from observations, interviews, and record reviews of large computer-selected resident samples. Stage 2 consists of systematic surveyor inves- tigations of triggered issues and residents using the Guidance to Surveyors as well as a set of investigative tools known as critical elements protocols. In addition to the Stage 1 and Stage 2 sample-based investigations, the QIS also contains several facility-level tasks that are unstaged and are completed either on every survey or when triggered as areas of concern (5). The QIS Standard Survey is composed of Tasks 1 through 9, and the Traditional Standard Survey is com- posed of Tasks 1 through 7. Both versions of the survey process are resident-centered, outcome- oriented inspections that rely on a case-mix stratified sample of residents to gather information about the facility’s compliance with participation requirements. Outcomes include both actual and potential negative outcomes, as well as failure of a facility to help residents achieve their highest practicable level of well-being. Based on the specific procedures detailed in Appendix P, a stan- dard survey assesses (5):

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compliance with residents’ rights and quality-of-life requirements;

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the accuracy of residents’ comprehensive assess- ments and the adequacy of care plans based on these assessments;

the quality of care and services furnished, as mea- sured by indicators of medical, nursing, rehabili- tative care, and drug therapy; dietary and nutrition services; activities and social participation; sanita- tion and infection control; and

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the effectiveness of the physical environment to empower residents, accommodate resident needs, and maintain resident safety, including whether requested room variances meet health, safety, and quality-of-life needs for the affected residents.

The Traditional Survey ●

● Task 1: Off-site Survey Preparation

Task 2: Entrance Conference/On-site Preparatory Activities

● Task 3: Initial Tour