Regulations, Legislation, and Advocacy

January 2018
CMS Megarule

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November 2017
Source: Centers for Medicare & Medicaid Services (CMS) 

Pub. 100-07 State Operations Provider Certification 

Transmittal 169- Advanced Copy 

SUBJECT: Revision to State Operations Manual (SOM) Appendix PP for Phase 2, F-Tag Revisions, and Related Issues 


42 CFR 483.70(h), F841-Responsibilities of Medical Director


Of the 700 pages of the new Mega Rule, there are approximately 20 pages which mention the Medical Director Section – 483.70(h). Each reference has been highlighted, but we suspect that there is much more hidden in the 700 pages.

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June 2017
Updates from CMS and Florida’s Agency for Health Care

1.Advanced Copy- Appendix Z, Emergency Preparedness Final Rule Interpretive Guidelines and Survey Procedures

2.State Operations Manual – Appendix Z- Emergency Preparedness for All Provider and Certified Supplier Types – Interpretive Guidance

3.Copy of Surveyor Tool-EP-Tags

4.Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease (LD)

December 2015
Administration Releases Final Report for 2015 Conference on Aging

September 2015
FMDA and FSU College of Medicine Sponsor High-Level Post-Acute and Long-Term Care Forums

August 2015
Medicare and Medicaid Programs; Reform of Requirements for Long‐Term Care Facilities

August 2015
Requirement for supplemental Medical Director training

August 2015
Use of Antipsychotics in Older Adults in the Inpatient Hospital setting

February 2015
FMDA Proposed Bylaws Amendments

January 2015
FMDA Resolution for AMDA’s HoD

May 2014
The State of Aging and Health in America: 2013

April 2014
CMS Update: Focused Minimum Data Set (MDS) and Dementia Care Surveys

April 2014
Long-Term Care Services in the United States: 2013 Overview

April 2014
Dementia Care: The Quality Chasm

December 2013
Statewide Medicaid Managed Care (SMMC) and Managed Medical Assistance (MMA) Webinar PPT presented December 10, 2013

October 2013
Cardiopulmonary Resuscitation (CPR) in Nursing Homes

November 2012
Florida Medical Directors Association Announces 3rd Annual Call for Presentations for Best Care Practices 2013

November 2012
National Leaders Enthuse Attendees at �Best Care Practices in the Post-Acute & Long-Term Care Continuum 2012�

November 2012
Physician Orders for Life-Sustaining Treatment (POLST) Form

January 2012 HB 7095: Pill Mill Bill

Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2011: Part One and Part Two

August 29, 2010
AMDA Comments on DEA Notice

August 2010
Prescribing controlled substances in long-term care: Tips for practicing clinicians on the go

March 12, 2010
ESA Medication Guide Enforcement

FDA Drug Safety Communication: Erythropoiesis-Stimulating Agents (ESAs): Procrit, Epogen and Aranesp

August 10, 2009
Interim Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting

August 10, 2009
Recommended Changes in Infection Control Precautions for Care of Patients with Confirmed or Suspected Novel Influenza A H1N1 in the Healthcare Setting

New Medicare Nursing Home Guidance to Include Quality of Life and Environment Requirements

Supervision Data Form for Physician Assistants

Medicare Launches Outreach Effort to Help Beneficiaries with New Program that Lowers Costs for Durable Medical Equipment

CMS Durable Medical Equipment Alert

April 11, 2008
Nursing Facility Services (Codes 99304 - 99318)

April 2008
Florida State Legislative Update

Medication Pass Clarification for Surveying F Tags 332 and 333 During Nursing Home Surveys

Potentially Harmful Drugs in the Elderly

March 13, 2007
Aspen State Regulation Set: N 2.07 Nursing Home Licensure

November 2006
The Newly Revised F-Tag 315 and Surveyor Guidance for Urinary Incontinence in Long Term Care; Theodore M. Johnson, II, MD, MPH, CMD, and Joseph G. Ouslander, MD, CMD. JAMDA

The New F-Tag 315, November 2006, Deborah Lekan-Rutledge. JAMDA

64B8-9.014. Standards for Telemedicine Prescribing Practice

January 16, 2006
Nursing Facility Services (Codes 99304 - 99318): Supervision

January 16, 2006
Nursing Facility Services (Codes 99304 - 99318)

January 6, 2006
Nursing Facility Services (Codes 99304 - 99318)

August 17, 2005
Non-Physician Practitioner (NPP) Questions and Answers

July 8, 2004
Addendum I to S&C Letter 04-24 on the Care for Residents of Long-Term Care (LTC) Facilities Who Receive End Stage Renal Disease (ESRD) Services

2004 CMS Request for Comment on Medical Director and Quality Assurance F tag Guidance

Advance copy of new surveyor guidance for determining nursing facilities� compliance with requirements at F501, Medical Director

AARP Public Policy Institute Publications

FMDA Joins Coalition of Health Care Provider Organizations to Promote Responsible Medicaid Reform

December 31, 2004
Senior Health Choices: A Managed, Integrated Long Term Care Plan

November 2003
Non-Physician Practitioner Questions and Answers

November 13, 2003
Physician Delegation of Tasks in Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs)

April 10, 2003
Physician delegation of tasks in Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs)


Advance copy of new surveyor guidance for determining nursing facilities� compliance with requirements at F501, Medical Director

On June 9th, the Centers for Medicare & Medicaid Services (CMS) issued to state survey agency directors the advance copy of new surveyor guidance for determining nursing facilities� compliance with requirements at F501, Medical Director. The new guidance, which is now available on CMS� web site, includes Interpretive Guidelines, an Investigative Protocol, and Severity guidance for assigning severity levels for deficiencies cited at F501. The regulation at F501 has not changed.

CMS will issue the final guidance in November 2005. According to CMS� cover memo, the intervening time period is intended �to allow surveyors to be trained in the new guidance and to permit facilities and medical directors to study the significantly revised and expanded guidance.� Changes in the content are not expected when CMS issues the final document.

ACHA key staff and subcommittee members are reviewing the guidance. In subsequent communications, we will provide additional information such as the content and significance of the guidance, as well as information and materials to help facilities understand and prepare for implementation.

The guidance also may be accessed as a Word Document by clicking here.

The AARP Public Policy Institute is pleased to make available a set of five publications on facts about the Medicaid program and the people it helps, by Lynda Flowers, Mary Jo Gibson, Wendy Fox-Grage, and Ari Houser.

For more information about Medicaid long-term care, please contact Mary Jo Gibson at (202) 434-3896. For more information about other Medicaid publications, please contact Lynda Flowers at (202) 434-3889. Original copies of all are available by request at or calling (202) 434-3890.

Created in 1965, Medicaid is a federal and state-funded program that most people think of as simply a health insurance program for low-income Americans. Today, Medicaid is the largest public or private health insurance program in the United States; this year, 53 million people are expected to be enrolled. Medicaid covers two-thirds of nursing home residents, one in five persons under age 65 with chronic disabilities (including about 70% of poor children), one-third of all births, and half of spending for states' mental health services.

There are many myths about the program, about what it covers, and the people it helps, including the misconception that most Medicaid beneficiaries are on welfare. This set of five documents aims to shed additional light on the Medicaid program - today's safety net for those who are unable to pay for their health and long-term care.

1. "SIX THINGS THAT YOU MIGHT NOT KNOW ABOUT THE MEDICAID PROGRAM," April 2005 (FS#113, 3 pages) - This Fact Sheet provides key facts about the Medicaid program that demonstrate why the program is such an important part of the nation's health care system.

2. "MYTHS ABOUT THE MEDICAID PROGRAM AND THE PEOPLE IT HELPS," April 2005 (FS#115, 4 pages) - This Fact Sheet provides the real facts surrounding nine common myths concerning Medicaid eligibility, services, and beneficiaries.

3. "MEDICAID OPTIONAL ELIGIBILITY AND SERVICES: OPTIONS THAT AREN'T REALLY OPTIONS," April 2005 (DD#115, 5 pages) - This Data Digest describes the role of "optional" categories in providing acute care services through the Medicaid program, and provides examples of how individuals and families benefit from such optional eligibility and/or optional services.

4. "SLICING THE LONG-TERM CARE SAFETY NET: MEDICAID'S MOST VULNERABLE AT RISK," April 2005 (DD#116, 4 pages) - This Data Digest looks at the role of "optional" Medicaid categories in providing long-term care services for older people and those with disabilities lacking sufficient resources to afford these services themselves.

5. "THE FACES OF MEDICAID LONG-TERM CARE BENEFICIARIES," April 2005 (FS#114, 2 pages) - This Fact Sheet uses vignettes to give examples of common situations faced by Medicaid beneficiaries who receive long-term care services including nursing facilities, personal care, and HCBS waiver services.

To view other publications on topics of importance to midlife and older Americans, please visit our webpage at Copies of all publications are available by request at or by calling (202) 434-3840.

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