Doctor with tabletWritten by Sherri Jankowski, RN, LNC

The Social Security Act (the Act) mandated the establishment of minimum health and safety standards that providers who participate in Medicare and/or Medicaid programs to benefit the residents/patients that receive care in specific settings.  The Federal government set many standards related to health care, including those specific to the Act.  Taking it one step further, the Centers for Medicare and Medicaid (CMS) established requirements following Federal Certification Standards for all facilities receiving Medicare and/or Medicaid.

In order to make sure that the facilities are in compliance with the established requirements, every state has a State Operation Manual (SOM) that contains the regulations created for standards of care.  Each SOM has an Appendix that included F-Tags for LTC facilities (including SNF’s), W-Tags for ICF’s (Intermediate Care Facilities, and G-Tags for Home Health Care agencies (HHC).   While this article focuses on F-Tags, similar procedures are done with W and G-Tags.

Surveyors, trained by each State on the SOM governing the State they are in, visit their assigned facilities, at least annually, to find out if each facility is providing the health and safety standards for their residents established by the government.  There are four main categories that apply to care and safety: Resident Behavior & Facility Practice, Quality of Life, Quality of Care, and Staffing.  In addition there are categories that apply to the facility structure and equipment as well.  Within these categories are many subcategories, and every one of them has an F-Tag attached. There is also some overlap, which can result in several F-Tag citations for one incident.

Each F-Tag is numbered by a federal regulation citation and has a title.  It then has a definition or intention of what it is for.  Following that is all the criteria to follow by facilities and staff and what a surveyor should expect to see.  Some have actual questions to ask the staff or residents.  Depending on what they see, and the answers they get, the surveyors will check on many different things to determine if everything is up to expected standards.  They will check Policy and Procedure Manuals, Care Plans, resident charts, documentation (including flow sheets, nursing notes, physician orders, MARs and TARs, and whatever else you may have), MDS, and even staffing records. They will interview residents, families, and staff.  Whether you pass or fail in each area, you will know by the end of the survey.

Any area that you failed in will result in a citation and require a Plan of Correction. Once completed in the time frame given, there will be follow-up by your State.  An F-Tag citation can run from no actual harm to potential for harm to actual harm of a resident.  Results can be sanctions, fines, and if severe enough, actual closure of a facility.  Understanding the F-Tags that cover your job at a facility is critical in making sure that you are following regulated Standards of Care within your job description.

F-Tags were created to provide a primary regulatory focus on Standards of Care that would provide a consistent level of care to achieve for all residents.  If everyone knows the F-Tags they need to follow, then a deficiency free survey should be the result and you will probably be working in a facility that has a waiting list for rooms.  Watch for my next Blog article that will give you a demonstration of care provided and the simple mistake that resulted in an F-Tag cite for actual harm.