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Category Archives: CMS Memo

Survey and Certification Memos

15-31:  Focused Dementia Care Survey Pilot (NH – 3/27/15)

Attached to this memo is a final report that outlines the basis for the Focused Dementia Care Survey Pilot, the process utilized, conclusions gathered based upon post-pilot data analysis, as well as next steps for the future.  The CMS plans to expand upon the work of the focused survey pilot and has invited States to conduct such surveys in FY2015 on a voluntary basis.  The expansion project will involve a more intensive, targeted effort to improve surveyor effectiveness in citing poor dementia care and the overutilization of antipsychotic medications, and broaden the opportunities for quality improvement among providers.  Deficient practices noted during the surveys will result in relevant citations.  In the event that additional care concerns are identified during on-site reviews, those concerns will be investigated during the survey or will be referred to the SA as a complaint for further review.  The memo is attached here and one attachment is attached here.

15-34:  Grant Award: Reinvestment of Federal Civil Money Penalty (CMP) Funds to Benefit Nursing Home Residents (NH – 4/3/15)

The Centers for Medicare & Medicaid Services (CMS) invited proposals for a grant opportunity to utilize Federal CMP Funds for the support and further expansion of the National Partnership to Improve Dementia Care in Nursing Homes.  The Eden Alternative, Inc. was deemed to be the most eligible applicant and has been awarded a grant, in the amount of $293,129.00, for their project entitled, “Creating a Culture of Person-Directed Dementia Care.”  The memo is attached here.

15-35:  Implementation of Section 6106 of the Affordable Care Act – Collection of Staffing Data for Long Term Care Facilities (NH – 4/10/15)

In this memorandum, CMS notified States of the posting of technical specifications and related information for the electronic submission of staffing information based on payroll data.  This information is posted at:  The memo is here.

CMS National Nursing Home Quality Care Collaborative (NNHQCC) Change Package v2.0 – Now Available

The Change Package developed as part of the CMS National Nursing Home Quality Care Collaborative is being used by CMS and Quality Improvement Organizations and is intended to complement evidence-based tools and resources.  A change package is a menu of strategies, change concepts and specific actionable items that any nursing home can choose from to begin testing for purposes of improving quality of care.

Please visit Advancing Excellence’s website here for more information and to download the full package.

RAI Manual Update

On February 5, 2015, CMS posted a new Errata document on the RAI manual page of their website.  It is designed so that you can remove the old page of the RAI and insert the new corrected page.  The revisions to pages in Chapter 2 & 3 clarify the meaning of entry/reentry and the coding for A1600, A1700, A1800 and A1900.  You can find the revised pages on CMS’s website by clicking here.

If you have any questions, please contact Stacey Kempker, BSN, RN, State RAI Coordinator for DHSS, by calling 573-751-6308 or via email at

CMS Announces Important Changes to Nursing Home Compare Website

CMS has announced that they are preparing to make changes to the Nursing Home Compare website this month.  Specific changes include:

  • Addition of two (2) quality measures for antipsychotic medication use in nursing homes to the Five Star rating system calculations.
  • Raising the standard for nursing homes to achieve a high rating on all measures publicly reported in the Quality Measure (QM) dimension on the website
  • Adjustment of the algorithm used for calculating staffing ratings to more accurately reflect staffing levels.

CMS discussed these important changes and the impact on the Five Star rating system during the CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum that was held Thursday, February 12, 2015.

Please visit here on the CMS website where you will find more information.

New Generations Quarterly Newsletter – Fall 2014

The Section for Long-Term Care has published New Generations – Volume 12, Issue 3, Fall 2014.  This issue is now accessible here.  Please visit our website here to view this edition along with an archive of previous newsletters.

Holidays & Decorating

It is that time of year when people are decorating their homes and businesses with festive décor and anticipating upcoming holiday celebrations.  Residents and staff in your care home also look forward to festivities and enjoy holiday decorations.  It is important for residents, staff and visitors to carry on traditions and to feel a sense of joy and peace we all want this time of year.

The Section for Long-Term Care Regulation (SLCR) wants to help you and your residents have a safe holiday season by sending out the following safety tips, references and regulatory reminders.

Fires or other accidents are not something anyone wants!

Safe decorations include:

  • Artificial Christmas trees and decorations that are non-combustible or flame retardant.
  • UL approved decorative lighting (use in supervised areas and turn off when not in use).
  • UL approved outdoor lighting.
  • Holiday decorations, including evergreen wreaths, ornaments, photos, etc. can be used on resident’s doors, and in hallways, as long as they do not exceed 3 ½” in depth and they are not blocking the entrances or exits.*

*Any combustible decorations hung from doors or walls in corridors may be used with a waiver. Non-rated combustible decorations cannot exceed 20% of the wall space in an exit egress corridor.

Although the 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) is the official reference, the 2012 Edition contains some less restrictive requirements.  Please refer to the CMS memo regarding waivers here: CMS Memo S&C 13-58-LSC 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) Waivers, or visit the CMS website at

Prohibited decorations include displays, hangings, and other decorations that block exits, visibility of exits, or fire protection appliances.  Never hang decorations from fire sprinkler heads or pipes.

NFPA 101, Section Combustible decorations shall be prohibited in any health care occupancy unless they are flame retardant.

NFPA 101, Section Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

NFPA 101, Section No furnishings, decorations, or other objects shall obstruct exits, access thereto, egress therefrom, or visibility thereof.

Please note, some county or city local ordinances may also require compliance with more restrictive standards, including the International Fire Code (IFC).

  •  F323:  Electrical Safety – Any electrical device, whether or not it needs to be plugged into an electric outlet, can become hazardous to the residents through improper use or improper maintenance.  Electrical equipment such as electrical cords can become tripping hazards.  Halogen lamps or heat lamps can cause burns or fires if not properly installed away from combustibles in the resident environment.  The Life Safety Code prohibits the use of portable electrical space heaters in resident areas.
  • Extension cords may be used on a TEMPORARY basis.  For information regarding the use of extension cords, please visit the SLCR website at
  •  Can candles be used in nursing homes under supervision, in sprinklered facilities?

CMS Memo S&C-07-07: Nursing Home Culture Change Regulatory Compliance Questions and Answers

Answer:  Regarding the request to use candles in sprinklered facilities under staff supervision, National Fire Protection Association data shows candles to be the number one cause of fires in dwellings.  Candles cannot be used in resident rooms, but may be used in other locations where they are placed in a substantial candle holder and supervised at all times while they are lighted.  Lighted candles are not to be handled by residents due to the risk of fire and burns.

This holiday season consider using battery-operated flameless candles.  They look and smell real!

We wish you a wonderful and safe holiday season.  If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8610.

CMS Memo S&C 14-46-LSC: Categorical Waiver for Power Strips Use in Patient Care Areas

Memo Summary:

  • Categorical Waiver:  CMS has determined that the 2000 edition of the National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) contains provisions on the use of power strips in health care facilities that may result in unreasonable hardship for providers or suppliers.  Further, an adequate alternative level of protection may be achieved by compliance with the 2012 edition of the LSC, which has extended allowances on the use of power strips in patient care areas.


  • CMS is permitting a categorical waiver to allow for the use of power strips in existing and new health care facility patient care areas, if the provider/supplier is in compliance with all applicable 2012 LSC power strip requirements and with all other 2000 LSC electrical system and equipment provisions.


  •  Resident rooms in long-term care or other residential care facilities that do not use line-operated electrical appliances for diagnostic, therapeutic, or monitoring purposes are not subject to the more restrictive NFPA 99 requirements regarding the use of power strips in patient care areas/rooms.  Resident rooms using line-operated patient-care-related electrical equipment in the patient care vicinity must comply with the NFPA 99 power strip requirement and may elect to utilize this categorical waiver.


  • Individual waiver applications are not required:  Providers and suppliers are expected to have written documentation that they have elected to use the waiver.  A provider or supplier must notify the LSC survey team at the entrance conference that it has elected the use the waiver permitted under this guidance and that it meets the applicable waiver requirements. The survey team will review the information and confirm the facility meets the conditions for the waiver.

Please see the complete memo here or visit