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Ftag of the Week – F727 RN 8 Hrs/7 days/Wk, Full Time DON

This week’s CMSCG Blog Series “Ftag of the Week” is F727 RN 8 hours a day / 7 days a week, Full Time DON, which is part of the Nursing Services Regulatory Group. This regulation is one that all providers are aware of, but it warrants a reminder thanks to a QSO memo released late last week about the Payroll-Based Journal (PBJ).

The regulation states that unless a waiver is in place:

  • A facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week
  • The facility must designate a registered nurse to serve as the director of nursing on a full-time basis (35 or more hours per week). The Interpretive Guidance states that the DON requirement can be fulfilled by using two or more RNs so long as the roles and responsibilities for all RN staff serving as the DON are clearly defined and facility staff understand how the responsibilities are shared.
  • The director of nursing may only serve as a charge nurse when the facility’s average daily census is 60 or fewer residents

The QSO memo regarding the use is Payroll-Based Journal staffing data for Nursing Home Compare and the Five Star Quality Rating staffing domain emphasizes the importance of RN hours in the nursing home. Facilities that have more than 7 days per quarter where RN hours per this regulation are not met will receive a 1-star rating for staffing for that quarter. This include facilities that have received an RN waiver. Even though these facilities do not have to have an RN on staff 8 hours a day / 7-days a week, they will be subject to the same rating methodology applied to facilities that have 7 or more days/quarter without RN staffing submitted to the PBJ system.

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