The Centers for Medicare and Medicaid Services (CMS) has issued a new Survey and Certification Letter related to Exit Conferences which provides direction on the following issues:

• CMS is issuing this clarification in response to questions regarding “…the degree of specificity surveyors should provide during the Exit Conference to Medicare/Medicaid providers and suppliers regarding deficiencies found during the conduct of federal surveys…”
• This memo applies to all surveyors for all types of Federal surveys [LTC and non-LTC).
• In accordance with these clarifications, CMS has revised the State Operations Manual (SOM), Chapters 2 and 5, and Appendix P [See the red-lined revisions attached to the memo].
• CMS states: “The Exit Conference during the onsite survey is both a courtesy to the provider and a way to expedite the provider’s planning ahead of the formal receipt of the…Form CMS-2567, Statement of Deficiencies. The purpose of the Exit Conference is to informally communicate preliminary survey team findings and provide an opportunity for the exchange of information… The findings or information conveyed at the Exit Conference are…subject to change pursuant to the State and CMS supervisory review processes… an Exit Conference is not always guaranteed, as is noted in section 2724 of the SOM.”
• Surveyors are instructed to generally respond to a provider request for the specific regulatory basis or specific tag, “…but must always caution the facility that such coding classifications are preliminary and are provided only to help the provider gain more insight into the issues through the interpretive guidance…”
• If the survey team is still deliberating the tag(s), it is not to speculate as to the specific tag that will be cited, but should describe the general area of non-compliance.
• States must follow the federal process. “State licensure laws do not override the procedures outlined in the federal survey process.”
• “…Under no circumstances…” are surveyors to provide Scope and Severity of a deficiency finding (except for immediate jeopardy), pending supervisory review. “Survey teams may describe the general seriousness (e.g., harm) or urgency that, in the preliminary view of the survey team, a particular deficiency may pose to the well-being of residents.” Surveyors are instructed to respond with the facts of the finding, i.e., “…noncompliance was found affecting X number of residents…” to scope-related inquiries.
• For LSC surveys, the survey team may follow the procedures for either non-LTC [as addressed in this memo/attached revisions] or LTC, depending on the degree to which the team finds the tags are important to provider understanding of the nature, location, and corrective actions for the deficiency.
• CMS will evaluate this policy on an ongoing basis and will re-evaluate the policy if it finds the process is undermined “…or results in providers/suppliers trying to unduly pressure surveyors, or influence the objectivity and fairness of the survey process…” .
• CMS clarifies that States must not leave draft CMS-2567 forms onsite before they are finalized stating, “This type of activity undermines the survey and certification process by shortening the time for the investigation and limiting the quality assurance process for the review of the CMS-2567 forms…”