The Centers for Medicare & Medicaid Services (CMS) updated its LTC Survey Resources folder with an effective date of 2/3/2026. Per the Revision History document, there were updates made due to iQIES and recent updates to Appendix Q, which is a vague set of updates. Here’s what you need to know.
LTCSP Documents and Files Updated 2/3/2026
Critical Element Pathways
The following are the revised Critical Element Pathways:
- CMS-20057 Resident Council Interview (2/2026)
- CMS-20058 Quality Assurance & Performance Improvement (QAPI) and Quality Assessment & Assurance (QAA Review) (2/2026)
- CMS-20082 Unnecessary Medications, Chemical Restraints/ Psychotropic Medications and Medication Regiment Review Critical Element Pathway (2/2026)
- Extended Survey (2/2026)
- CMS-20132 Discharge Critical Element Pathway (2/2026)
- CMS-20081 Respiratory Care Critical Element Pathway (1/2026)
The revisions to the Respiratory Care Critical Element Pathway are the most significant of the tools listed above. Related to oxygen, new observations have been added related to Smoking Signs:
- Smoking Facilities: Are doors labeled “No Smoking” at all locations where oxygen is stored or used?
- Non-Smoking Facilities: Are “No Smoking” signs posted at all major entrances and on doors to all oxygen storage locations?
Two additional “other tags to consider” which could be linked to these revisions include F689 Free of Accident Hazards/ Supervision/ Devices and F926 Smoking Policies.
Long Term Care Survey Process (LTCSP Procedure Guide)
A revised LTCSP guide has been added with an effective date of February 3, 2026. Some information to be aware of:
- Procedures for reviewing the CASPER PBJ Staffing Data Report have expanded guidance which indicates that for standard recertification surveys with a staffing-related complaint/Ombudsman concern, the Team Coordinator may need to review previous quarters of staffing data reflecting a specific time period. Currently, if there are no staffing-related concerns/ complaints, only the most recent quarter of staffing data is reviewed before survey.
- Closed record review guidance has also been revised to assist the survey team with selecting which resident is the best one to be investigated for the required areas of discharge, hospitalization and death.
- Transmission-based precautions information been added to the guidance related to increasing the sample size if needed.
- During the Resident Council interview, the section on Arbitration should be skipped if arbitration was triggered during the Entrance Conference. Otherwise, if residents have been asked to enter into binding arbitration agreements, this will be discussed during the Resident Council meeting.
LTCSP Procedure – Extended Survey
The guidance has been expanded to include information on which tasks are performed by surveyors during extended/ partial extended surveys. These tasks include:
- Reviewing a larger sample of resident assessments than what is used in a standard survey
- Reviewing staffing
- Reviewing in-service training
- Examination of consultant contracts, as applicable
- Review of policies and procedures related to requirements where deficient practices were identified
- Investigation of any requirement of participation per the State Agency’s discretion
The LTCSP Mapping Document has also been updated as of 2/2026.
Schizophrenia Getting Lots of Initial Pool Attention
Newly added Initial Pool areas include:
- New Schizophrenia and No Antipsychotic (for new admissions) – determine if the resident is at least 65 years or older and has a new diagnosis of schizophrenia since admission (Record Review)
- No Antipsychotic with New Schizophrenia Diagnosis (for MDS Indicator) – determine if the resident has a new diagnosis of schizophrenia (Record Review)
Other changes:
- The Unsafe Wandering/Elopement Initial Pool area has updated intent –
- Leaving secured areas or entering residents’ rooms without staff redirection or preventative measures in place
- Attempted to leave building without alarm working
- Concerns regarding unsafe wandering: Eloped in last 120 days (existing language with the bold indicating new language)
- The Extended Survey has now been linked to the Facility Assessment task.
- F731 Waiver of RN Coverage and 24-hour Licensed Nurse Requirement has been added to the list of F-tags Not Mapped to a Care Area.
You can download the Survey Resources folder (.zip) from the cms.gov website. If you’re looking for a list of current Critical Element Pathways, check back on the CMSCG Blog shortly.
