Check out CMS’s new Quality in Focus interactive video series. The series of 10-15 minute videos are tailored to provider types and aim to reduce the deficiencies most commonly cited during the CMS survey process, like infection control and accident prevention. Reducing these common deficiencies increases the quality of care for people with Medicare and Medicaid.

Learn to:

• Understand surveyor evaluation criteria
• Recognize deficiencies.
• Incorporate solutions into your facility’s standards of care

See the Quality, Safety, & Education Portal Training Catalog, and select Quality in Focus.

A couple important reminders regarding the requirements for issuing Notices of Medicare Non-Coverage (NOMNC) and Discharge Notices. These two requirements are separate and cannot be used interchangeably.

Notice of Medicare Non-Coverage (NOMNC), Form CMS-10123

• The NOMNC form is provided to Medicare beneficiaries in skilled nursing facilities and informs them that their Medicare covered services are ending.
• Guidance from F581 includes:
  • The NOMNC must be given to all Medicare beneficiaries at least two days before the end of a Medicare covered Part A stay or when all Part B therapies are ending. The NOMNC informs beneficiaries of their right to an expedited review by a Quality Improvement Organization. Note the following exceptions: the beneficiary exhausts the SNF benefits coverage (100 days), the beneficiary initiates the discharge from the SNF, or the beneficiary elects the hospice benefit or revokes the hospice benefit to return to standard Medicare coverage.

Discharge Notice

• The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless certain criteria are met, outlined in F627.
• The facility must notify the resident and the resident’s representative of the reasons for discharge and a copy of the discharge notice must be provided to the Ombudsman. (F628)
• Guidance from F628 includes:
  • For residents discharged home after a Medicare Part A stay, the discharge notice must be provided along with the NOMNC. The NOMNC does not replace the requirement for a discharge notice.
  • A discharge notice must be issued to residents regardless of the length of their stay. For example, if the resident is admitted for rehab and their Medicare Part A stay ends at 21 days, a discharge notice must still be issued. The notice must be issued “as soon as practicable” in this instance since the resident has not resided in the facility for more than 30 days.

The National Long-Term Care Ombudsman Resource Center has created a helpful resource for facilities highlighting the changes regarding Transfer and Discharge Notices, in Appendix PP that were effective April 25, 2025. We encourage facilities to review these requirements carefully and ensure that both the NOMNC and discharge notices are issued appropriately to comply with federal regulations and to protect the rights of residents.

Skilled Long-Term Care Facilities who receive citations resulting in denial of payment effectuation, partial or extended survey, and/or civil monetary penalties over $13,343 (or as adjusted annually for inflation) will be prohibited from approval of the CNA Training Program for a 24-month time frame. This means the facility is not able to complete the 75 hours of instructional training as well as the 16 of the 100 hours of on-the-job training. The facility can only provide 84 of the 100 hours of clinical training with an approved clinical supervisor or instructor. To check for approved training facilities visit Certified Nurse Assistant (CNA) | CNA, CMT and Insulin Registry | Health & Senior Services and click on CNA Approved Facility Training Agencies.

Some facilities may be eligible for a federal waiver. If approved, this allows the facility to provide 175 hours of training with a sponsor. For more information, contact the Health Education Unit at 573-526-5686 or you may email us at CNARegistry@health.mo.gov.

On November 18, 2024, the Centers for Medicare and Medicaid Services (CMS) released revised guidance for nursing home surveyors. Surveyors began using this revised guidance on April 28, 2025. As part of this revision, CMS has removed the terms “facility-initiated” and “resident-initiated” when referring to discharges. The updated guidance reiterates the language at 483.15(c)(3) that requires facilities to send a copy of all notices of transfer or discharge to the representative of the Office of the State Long-Term Care Ombudsman Program.

The Long-Term Care Ombudsman Program has developed an easy and efficient way for facilities to meet the ombudsman notification requirement for transfers and discharges. By completing the Transfer Discharge Ombudsman Notice and uploading the transfer/discharge notice, the requirement to notify the ombudsman program will be complete. Once the notice is submitted, the facility will receive an email notification as proof of submission. Completion of the survey with the notice attached will take the place of the monthly list and emailed notices to the regional programs. Requirements for content of transfer/discharge notices can be found at §483.15(c)(5).