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Centers for Medicare & Medicaid Services Announces Revisions to Interpretive Guidelines

Changes Target Quality of Life and Environment

Centers for Medicare & Medicaid Services

On April 10, 2009, the Centers for Medicare & Medicaid Services announced changes to the Guidance to Surveyors for several Quality of Life and Environment section Tags. These changes add clarifications to assist surveyors in determining compliance with these Tags. Revisions have ground-breaking implications for resident choice, environment and quality of life.

According to CMS revisions were "in response to public recommendations from the 2008 CMS/Pioneer Network Environment Symposium."  Click here to view information on the Symposium and click here to view additional follow-up activities.

This revision will be implemented June 17, 2009. At that time, a final copy of this new guidance will be available at and ultimately incorporated into Appendix PP of the State Operations Manual.

The CMS memorandum cites examples of revisions as, "Residents have the right to have a choice over their schedules, consistent with their interests, assessments, and plans of care. Choice over "schedules" includes (but is not limited to) choices over the schedules that are important to the resident, such as daily waking, eating, bathing, and the time for going to bed at night. Residents have the right to choose health care schedules consistent with their interests and preferences, and the facility should gather this information in order to be proactive in assisting residents to fulfill their choices."

Click here to download the CMS memorandum and the following files:

  • Transmittal Sheet describing changes;
  • Advance copy of surveyor guidance revision; 
  • Guidance Training Instructor Guide outline in Microsoft Word;
  • Article on person-centered word usage to accompany F241 Dignity revision.

Please check back as the Pioneer Network continues to provide information and resources on revisions to the Interpretive Guidelines and the ground-breaking implications for our nation's elders!

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