In recently released updates to State Operations Manual Chapter 5 (Complaint Procedures) and Chapter 7 (Survey & Enforcement for Nursing Homes), multiple revisions to Chapter 7 were announced in two QSO Memos, one in February and another in April.
Per the QSO Memo, “Revisions to the State Operations Manual (SOM) Chapters 5 and 7,” updated guidance to Chapter 7 includes a laundry list of items related to oversight, investigation procedures, enforcement actions, and the CMP Reinvestment Program (CMPRP). Revision were made to survey guidance and instructions which were included in Appendix P (removed in 2017 due to the LTCSP launch). Due to the number of updates, we will be reviewing these changes in several posts.
Definitions
CMS tweaked and added some new definitions to Chapter 7, but none of the terms are “new” for providers – they’re just new to the Manual. Some updates were additions/ clarifications of definitions, such as “abuse,” “neglect,” “nurse aide,” “facility,” and “resident representative.”
Some survey-related items were also added:
“Instance of noncompliance” is a factual and temporal occurrence when a facility is not in substantial compliance with the requirements for participation. Each instance of noncompliance is sufficient to constitute a deficiency, and a deficiency may be comprised of multiple instances of noncompliance.
“Plan of Correction (PoC)” is a plan developed by the facility and approved by CMS or the State agency that describes the actions the facility will take to correct deficiencies and specifies the date by which those deficiencies will be corrected.
The definition for “Substandard Quality of Care (SQC)” was expanded to include the regulatory groups under which SQC could be identified. SQC deficiencies are those which constitute immediate jeopardy, a pattern of widespread actual harm that is not IJ, or a widespread potential for more than minimal harm but less than IJ with no actual harm (for certain tags).
Related to the definition of “new admission,” Chapter 7 now specifies that residents who are admitted before the effective date of a denial of payment who are taking a temporary leave are not considered new admissions, nor are they subject to the denial of payment.
Nursing Facility Staffing Waivers
Information on waivers, regulatory requirements and processes for the following sections were added:
- 7014.1 – Waiver of Nurse Staffing Requirements
- 7014.1.1 – SNF Waiver of Requirement for a RN More than 40 Hours a Week
- 7014.1.2 – NF-Only Waivers of Nurse Staffing Requirements in Nursing Facilities
- 7013.1.3 – Waivers of Nurse Staffing Requirements for Dually Participating Facilities (SNF/NF)
Life Safety Code Waiver
Section 7014.2 and its subsections have been updated related to LSC waivers. This includes waivers related to resident rooms.
In an accompanying post, we’ll review the updates to Chapter 7 related to the Long-Term Care Survey Process (LTCSP) as well as what’s in the revised QSO Memo from April 3, 2026. View CMS QSO Memo Ref: QSO-26-03-NH and the April 2026 revision QSO-26-03-NH (REVISED) for more information.
