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In November 2024, the Centers for Medicare and Medicaid Services (CMS) released Revised Long-Term Care (LTC) Surveyor Guidance. The memo included significant changes to guidance in Appendix PP. The memo was updated January 16, 2025, to include additional changes to the guidance. The changes will be effective and surveyors will begin surveying based on the revised guidance, on March 24, 2025. Note: The effective date was delayed from the original memo.
The memo outlines that CMS is amending the surveyor guidance for F918 to clarify the intent and application of the requirement. F918 addresses the requirements around the location and accessibility of toilet and bathing facilities. CMS defines key definitions including what is meant by the terms bathing facilities, toilet facilities and located near. The requirement states that each resident room must be equipped with, or located near, toilet and bathing facilities.
For facilities that receive approval of construction plans from state and local authorities or are newly certified after November 28, 2016, each residential room must have its own bathroom equipped with at least a commode and sink.
CMS has clarified the applicability of the requirements, specifically addressing when a bathroom is required within each resident bedroom. Moving forward, facilities that meet any of the following criteria must meet the requirement to provide each resident bedroom with its own bathroom consisting of at least a sink and toilet:
- A facility that received approval for construction from the state or local authority after November 28, 2016.
- A facility that is newly certified after November 28, 2016.
- A facility that completes a change of ownership and the new owner does not accept assignment of the existing provider agreement resulting in a “new initial certification” for a new provider agreement that is effective after November 28, 2016.
- A facility whose provider agreement was terminated by CMS, and a new provider is working to reenroll in the Medicare program as a newly certified facility effective after November 28, 2016.
Additional takeaways include but are not limited to the following:
- Know and maintain the dates of facility construction approvals and CMS certification. This includes separate dates for additions or significant renovations.
- Recognize the ramifications around ownership change when the new owner does not accept assignment of the existing provider agreement.
- Recognize the consequences when a provider agreement is terminated, and a new provider attempts to re-enroll as a newly certified facility.
- Consider utilizing design professionals with specific knowledge in CMS requirements, Life Safety Code® compliance, and the Healthcare Facility Guidelines (FGI) when designing for a new build action items and a check list which can assist your facilty with regulatory compliance.
Additional information can be found in AHCA’s Action Tool F918 Bathing and Toilet Facilities. As a result of the updated CMS memo, additions and extending the effective date for the Appendix PP changes have been made to AHCA’s webinar, AHCA Education: Preparing for Upcoming CMS Guidance Changes: Key Updates and Action Items for Compliance. This webinar is on demand and available free to AHCA/NCAL members and $65 non-members. Remember if you are a member of Washington Health Care Association, you are also a member of AHCA and take advantage of this free resource. Please send questions to regulatory@ahca.org, and email educate@ahca.org if you need assistance with registering.
Thank you to AHCA for the development of the information contained within this communication and the associated tools. If you have questions, please contact Elena Madrid, Executive Vice President of Education and Regulatory Affairs.
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