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Client Alert: CMS Again Delays Updates to its Guidance to Surveyors for Long Term Care Facilities Under Appendix PP of the State Operations Manual

Date: March 11, 2025
On March 10, 2025, the Centers for Medicare & Medicaid Services (“CMS”) announced a further delay in the implementation of proposed updates to its Guidance to Surveyors for Long-Term Care Facilities under Appendix PP of the CMS State Operations Manual (the “Guidance”). The March 10, 2025, announcement delays the implementation of updates to the Guidance until April 28, 2025. Proposed updates to the Guidance, originally issued on November 18, 2024 (with a proposed effective date of February 24, 2025), were the subject of a January 16, 2025, delay that pushed back the effective date to March 24, 2025. In its January 16, 2025 announcement, CMS proposed further updates to the Guidance, including with respect to ensuring sufficient staffing to meet resident needs (F725), allowing a Director of Nursing to fulfill the requirement for maintaining a registered nurse onsite eight consecutive hours per day/seven days per week (F727) and requiring surveyors to review a facility’s recent Payroll Base Journal data prior to survey (F851). Under the March 10, 2025, announcement, CMS maintained the same updates issued January 16, 2025, only making changes to the form documents attached to Appendix PP, to be used as part of the facility survey process.              

What This Means for Providers     

Long-term care facility providers are encouraged to continue monitoring for further updates to Appendix PP of the CMS State Operations Manual, including with respect to the proposed effective date for such updates. The delay in implementation of the above Guidance, coupled with the issuance of various Executive Orders from the Trump administration in recent weeks, suggests CMS may be considering further updates before making the revised Guidance permanent. Providers are also encouraged to review Whiteford’s prior summary of updates currently being considered, available here.
 
If you have questions or need guidance on nursing home survey issues (including deficiencies and penalties) and/or compliance with Medicare Requirements of Participation, please contact krene@whitefordlaw.com. 
The information contained here is not intended to provide legal advice or opinion and should not be acted upon without consulting an attorney. Counsel should not be selected based on advertising materials, and we recommend that you conduct further investigation when seeking legal representation.