Moving into 2025, CMS has noticed comprehensive revisions to its surveyor guidance, which are set to go into effect in February 2025. Actionable revisions include those related to Transfer and Discharge, among other F-tags. Fundamentally, the revisions remove all references to “facility-initiated” and “resident-initiated” discharges. This change eliminates a confusing piece of the guidance added during the 2017 revisions that was not tethered to the text of the regulation. Instead, the advanced copy of the updated guidance focuses on whether the facility’s evidence supports the stated reason for discharge. In addition, CMS condensed the F-tags related to Transfer and Discharge into tags F-627 and F-628. While CMS’ Memorandum emphasizes that the changes will “reduce the overlap of citations, improve clarity, and make it easier for surveyors to identify noncompliance,” the changes to the Transfer and Discharge guidance also rein back the guidance to bring it closer in line to the regulation after a term in which the Supreme Court issued the Loper Bright decision.

Unfortunately, the change in the guidance also comes with a statement that a skilled nursing facility will now be required to include in its plan of correction either that it will “1) Re-admit the resident until a safe and compliant discharge can be done, or 2) Coordinate a transfer of the resident to another setting where they will be safe.” Although this issue has come up in several district offices over the years, this requirement was not previously included in the guidance and creates a number of problems. Not only that, but the guidance further states that “the facility should not be returned to substantial compliance until one of these two items is complete”—potentially extending the dates for noncompliance significantly. Coupled with that, CMS states that its State Survey Agencies should implement immediate remedies, including a discretionary denial of payment for new admissions within either 2 or 15 days, as applicable. Finally, CMS clarifies in the advance copy that it will generally cite Transfer and Discharge deficiencies at or above the “actual harm” level.