CMS Memo: QSO-22-19-NH: Revised Long-Term Care Surveyor Guidance: Revisions to Surveyor Guidance for Phases 2 & 3, Arbitration Agreement Requirements, Investigating Complaints & Facility Reported Incidents, and the Psychosocial Outcome Severity Guide

  • Clarifications and technical corrections of Phase 2 guidance issued in 2017 in certain areas, such as abuse and neglect, admission, transfer, and discharge, and improving care for individuals with mental health or substance use disorder needs, Payroll Based Journal, visitation, and inaccurate diagnoses of schizophrenia.
  • New guidance for Phase 3 requirements which went into effect in November 28, 2019, including guidance related to Infection Preventionist requirements.
  • Guidance for other Phase 3 requirements, such as Trauma Informed Care, Compliance and Ethics, and Quality Assurance Performance Improvement (QAPI). The revisions can be found in Appendix PP of the SOM.
  • Arbitration requirements and guidance which went into effect in September 16, 2019. Changes in the Psychosocial Severity Guide.
  • Revised guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and Facility Reported Incidents (FRIs).

Effective date: The effective dates for all requirements is October 24, 2022. The implementation date for the Chapter 5 revised guidance will be announced at a later date. CMS will establish a target implementation date for State Agencies (SAs) depending on the status of the PHE, and/or unique circumstances occurring in the SAs. The Implementation date will be communicated through the listserv.

SLCR will be providing a high-level overview of the requirements at the annual Provider Meetings; however, we encourage all homes to view the QSEP trainings below developed by CMS prior to the Provider Meetings. The trainings are titled:

Please see the full memo for complete details at