List of Revised FTAGs - CMS Compliance Group

1 Long Term Care Rule | F Tag: Job Aid* Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in RedFederal Regulatory Groups for Lon g Term Care Resident RightsF550*Resident Rights/Exercise of RightsF551 Rights Exercised by RepresentativeF552 Right to be Informed/Make Treatment DecisionsF553 Right to Participate in Planning CareF554 Resident Self Admin Meds Clinically AppropriateF555 Right to Choose/Be Informed of Attending PhysicianF557 Res pect , Dignity/Right to have Personal Pro pertyF558*Reasonable Accommodations of Needs/PreferencesF559*Choose/Be notified of Room/Roommate ChangeF560 Right to Refuse Certain TransfersF561*Self DeterminationF562 Immediate Access to ResidentF563 Right to Receive/Deny VisitorsF564 Inform of Visitation Rights/Equal Visitation PrivilegesF565*Resident/Family Group and ResponseF566 Right to Perform Facility Services or RefuseF567 Protection/Management of Personal FundsF568 Accounting and Records of Personal FundsF569 Notice and Conveyance of Personal FundsF570 Surety Bond Security of Personal FundsF571 Limitations on Char ges to Personal FundsF572 Notice of Rights and RulesF573 Right to Access/Purchase Copies of

2 RecordsF574 Required Notices and Contact InformationF575 Required PostingsF576 Right to Forms of Communication with PrivacyF577 Right to Survey Results/Advocate Ag enc y InfoF578 Request/Refuse/Discontinue Treatment;Formulate Adv DiF579 Posting/Notice of Medicare/Medicaid on AdmissionF580 Notify of Changes (Inj ury/Decline/Room, Etc. )F582 Medicaid/Medicare Coverage/ Liability NoticeF583 Personal Privacy/Confidentiality of RecordsF584*Safe/Clean/Comfortable/ Homelike EnvironmentF585 GrievancesF586 Resident Contact with External Freedom from Abuse, Neglect, and ExploitationF600*Free from Abuse and NeglectF602*Free from Misappropriation/ExploitationF603*Free from Involuntary SeclusionF604*Right to be Free from Physical RestraintsF605*Right to be Free from chemical RestraintsF606*Not Employ/Engage Staff with Adverse ActionsF607*Develop/Implement Abuse/Neglect, etc.

3 PoliciesF608*Reporting of Reasonable Suspicion of a CrimeF609*Reporting of Alleged ViolationsF610*Investigate/P revent/Correct Alleged Admission, Transfer, and DischargeF620 Admissions Polic yF621Eq ual Practices Regardless of Payment SourceF622 Transfer and Discharge RequirementsF623 Notice Requirements Before Transfer/DischargeF624 Pre paration for Safe/Orderly Transfer/DischargeF625 Notice of Bed Hold Polic y Before/Up on TransferF626 Permi ng Residents to Return to Resident AssessmentsF635 Admission Physician Orders for Immediate CareF636 Comprehensive Assessments & TimingF637 Comprehensive Assmt A er Significant ChangeF638 Quarterly Assessment At Least Ever y 3 MonthsF639 Maintain 15 Months of Resident AssessmentsF640 Encoding/Transmi ng Resident AssessmentF641 Accuracy of AssessmentsF642 Coordina on/Cer fica on of AssessmentF644 Coordina on of

4 PASARR and AssessmentsF645 PASARR Screening for MD & IDF646MD/ID Significant Change Comprehensive Resident Centered Care PlansF655 Baseline Care PlanF656 Develop/Implement Comprehensive Care PlanF657 Care Plan Timing and RevisionF658 Services Provided Meet Professional StandardsF659 Qualified PersonsF660 Discharge Planning ProcessF661 Discharge Quality of LifeF675*Quality of LifeF676*Ac vi es of Daily Living (ADLs)/ Maintain Abili esF677*ADL Care Provided for Dependent ResidentsF678*Cardio Pulmonary Resuscita on (CPR)F679*Ac vi es Meet Interest/Needs of Each ResidentF680*Qualifica ons of Ac vity Quality of CareF684*Quality of CareF685*Treatment/Devices to Maintain Hearing/VisionF686*Treatment/Svcs to Prevent/Heal Pressure UlcersF687*Foot CareF688*Increase/Prevent Decrease in ROM/MobilityF689*Free of Accident Hazards/Supervision/DevicesF690*Bowel/Bl adder Incon nence, Catheter, UTIF691*Colostomy, Urostomy.

5 Or Ileostomy CareF692*Nutri on/Hydra on Status MaintenanceF693*Tube Feeding Management/Restore Ea ng SkillsF694*Parenteral/IV FluidsF695*Respiratory/Tracheostomy care and Suc oningF696*ProsthesesF697*Pain ManagementF698*DialysisF699*{PHASE 3} Trauma Informed Care F700* Physician ServicesF710 Resident's Care Sup ervised by a PhysicianF711 Physician Visits Review Care/Notes/OrderF712 Physician Visits Fre quenc y/Timeliness/Alternate NPPsF713 Physician for Emergenc y Care , Available 24 HoursF714 Physician Dele ga on of Tasks to NPPF715 Physician Dele ga on to Die Nursing ServicesF725 Sufficient Nursing StaffF726 Com petent Nursing StaffF727RN 8 Hrs /7 days/ Wk, Full Time DONF728 Facility Hiring and Use of Nurse F729 Nurse Aide Registry Verifica on, RetrainingFriday, July 14, 2017 Page 1 of 2 Report 30.

6 LTC Rule Job Aid* Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in RedFederal Regulatory Groups for Lon g Term Care FacilitiesF730 Nurse Aide Perform Review 12Hr /Year In serviceF731 Waiver Licensed Nurses 24Hr /Da y and RN CoverageF732 Posted Nurse Staffing Informa Behavioral Health ServicesF740 Behavioral Health ServicesF741 Sufficient/Competent Staff Behav Health NeedsF742*Treatment/Svc for Mental/Psychosocial ConcernsF743*No Pattern of Behavioral Difficulties Unless UnavoidableF744*Treatment /Service for DementiaF745*Provision of Medically Related Social Pharmacy ServicesF755 Pharmacy Svcs /Procedures/Pharmacist/RecordsF756 Dru g Regimen Review, Report Irre gular.

7 Act OnF757*Drug Regimen is Free From Unnecessary DrugsF758*Free from Unnec Psychotropic Meds/PRN UseF759*Free of Medica on Error Rate sof 5% or MoreF760*Residents Are Free of Significant Med ErrorsF761 Label/Store Drugs & Laboratory, Radiology, and Other Diagnostic SeF770 Laboratory ServicesF771 Blood Blank and Transfusion ServicesF772 Lab Services Not Provided On SiteF773 Lab Svs Physician Order/No fy of ResultsF774 Assist with Transport Arrangements to Lab SvcsF775 Lab Reports in Record LabName/AddressF776 Radiology/Other Dia gnostic ServicesF777 Radiology/Dia g. Svcs Ordered/No fy ResultsF778 Assist with Transport Arrangements to RadiologyF779X Ra y/Dia gnos c Report in Record Si gn/ Dental ServicesF790 Rou ne/Emergency Dental Services in SNFsF791 Rou ne/Emergency Dental Services in Food and Nutrition ServicesF800 Provided Diet Meets Needs of Each ResidentF801 Qualified Dietary StaffF802 Sufficient Dietary Support PersonnelF803 Menus Meet Res Needs/Pre p in Advance/FollowedF804 Nutri ve Value/A ppear , Palatable/Prefer Tem pF805 Food in Form to Meet Individual NeedsF806 Resident Allergies.

8 Preferences and Subs tutesF807 Drinks Avail to Meet Needs/Preferences/ Hy dra onF808 Therapeu c Diet Prescribed by PhysicianF809 Fre quency of Meals/Snacks at Bed meF810 Assistive Devices Ea ng Eq uipment/UtensilsF811 Feeding Asst Training/Supervision/ResidentF812 Food Procurement, Store/Prepare /Serve SanitaryF813 Personal Food Polic yF814 Dis pose Garbage & Refuse Pro perl Specialized Rehabilitative ServicesF825 Provide/Obtain Sp ecialized Rehab ServicesF826 Rehab Services Ph ysician Order/Qualified AdministrationF835 AdministrationF836 License/Comply w/Fed/State/Local Law /Prof StdF837 Governing Bod yF838 Facility AssessmentF839 Staff QualificationsF840 Use of Outside ResourcesF841 Res ponsibili es of Medical DirectorF842 Resident Records Identifiable InformationF843 Transfer Agreement F844 Disclosure of Ownership RequirementsF845 Facility closure AdministratorF846 Facility closureF849 Hospice ServicesF850*Qualifications of Social Worker >120 BedsF851 Payroll Based

9 Quality Assurance and Performance ImprovemF865 QAPI Program/Plan, Disclosure/Good Faith AttemptF866 {PHASE 3} QAPI/QAA Data Collec on and MonitoringF867 QAPI /QAA Improvement Ac vi esF868 QAA Infection ControlF880 Infection Prevention & ControlF881 Antibiotic Stewardship Pro gramF882 {PHASE 3} Infec on Preven onist Qualifica ons /RoleF883*Influenza and Pneumococcal Immuniza {PHASE 3} Compliance and Ethics ProgramF895{PHASE-3} Compliance and Ethics Physical EnvironmentF907Sp ace and Eq uipmentF908 Essen al Equipment, Safe Opera ng Condi onF909 Resident BedF910 Resident RoomF911 Bedroom Number of ResidentsF912 Bedrooms Measure at Least 80 Square Ft/ResidentF913 Bedrooms Have Direct Access to Exit CorridorF914 Bedrooms Assure Full Visual PrivacyF915 Resident Room WindowF916 Resident Room Floor Above GradeF917 Resident Room Bed/Furniture/ClosetF918 Bedrooms Eq uipp ed/Near Lavatory/ToiletF919 Resident Call Sy stemF920 Requirements for Dining and Activity RoomsF921 Safe/Func onal/Sanitary/ Comfortable EnvironmentF922 Procedures to Ensure Water AvailabilityF923 VentilationF924 Corridors Have Firmly Secured HandrailsF925 Maintains Effec ve Pest Control Pro gramF926 Smoking Training RequirementsF940{PHASE 3} Training

10 Requirements GeneralF941{PHASE 3} Communication TrainingF942{PHASE-3} Resident s Rights TrainingF943 Abuse, Neglect, and Exploitation TrainingF944{PHASE 3} QAPI TrainingF945{PHASE 3} Infection Control TrainingF946{PHASE-3} Compliance and Ethics TrainingF947 Required In Service Training for Nurse AidesF948 Training for Feeding AssistantsF949{PHASE-3} Behavioral Health TrainingFriday, July 14, 2017 Page 2 of 2 Report 30: LTC Rule Job AidF906 Emergency Electrical Power System