Do You Have the Current LTCSP Critical Element Pathways?

The current Long-Term Care Survey Process (LTCSP) Critical Element Pathways are included in the 8/2024 Survey Resources folder. If you aren’t sure that you have the most current forms in use by surveyors, here’s each document and its date for your reference.

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NOTE: Critical Element Pathways which were provided with the advance copy of Appendix PP are noted with an asterisk. The revised forms – which are not effective until April 28, 2025, can be found at the end of this document.

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Current Critical Element Pathways

SNF Beneficiary Notification Review 10/2022 (CMS-20052 Beneficiary Notice)

Dining Observation 10/2022 (CMS-20053 Dining)

Infection Prevention, Control & Immunizations 8/2024 (CMS-20054 Infection Prevention Control and Immunization)

Kitchen/Food Service Observation 10/2022 (CMS-20055 Kitchen)

Medication Administration Observation 11/2017 (CMS-20056 Med Admin)

Resident Council Interview 10/2022 (CMS-20057 Resident Council)

Quality Assurance & Performance Improvement (QAPI) and Quality Assessment & Assurance (QAA) Review 10/2022 (CMS-20058 QAPI and QAA)*

Abuse Critical Element Pathway 10/2022 (CMS-20059 Abuse)

Environmental Observations 10/2022 (CMS-20061 Environment)

Sufficient and Competent Nurse Staffing Review 10/2023 (CMS-20062 Sufficient and Competent Staff)*

Personal Funds Review 10/2022 (CMS-20063 Personal Funds)

Activities Critical Element Pathway 10/2023 (CMS-20065 Activities)

Activities of Daily Living (ADL) Critical Element Pathway 10/2023 (CMS-20066 Activities of Daily Living)

Behavioral and Emotional Status Critical Element Pathway 10/2023 (CMS-20067 Behavioral-Emotional)

Urinary Catheter or Urinary Tract Infection Critical Element Pathway 4/2024 (CMS-20068 Urinary Catheter or UTI)

Communication and Sensory Problems (Includes Hearing and Vision) Critical Element Pathway 10/2023 (CMS-20069 Comm-Sensory)

Dental Status and Services Critical Element Pathway 4/2024 (CMS-20070 Dental)

Dialysis Critical Element Pathway 4/2024 (CMS-20071 Dialysis)

General Critical Element Pathway 2/2017 (CMS-20072 General)

Hospice and End of Life Care and Services Critical Element Pathway 5/2017 (CMS-20073 Hospice and End of Life)

Death Critical Element Pathway 10/2023 (CMS-20074 Death)

Nutrition Critical Element Pathway 10/2023 (CMS-20075 Nutrition)

Pain Recognition and Management Critical Element Pathway 10/2023 (CMS-20076 Pain Mgt)*

Physical Restraints Critical Element Pathway 10/2023 (CMS-20077 Physical Restraints)

Pressure Ulcer/Injury Critical Element Pathway 4/2024 (CMS-20078 Pressure Ulcer)

Specialized Rehabilitative or Restorative Services Critical Element Pathway 10/2023 (CMS-20080 Rehab and Restorative)

Respiratory Care Critical Element Pathway 4/2024 (CMS-20081 Respiratory Care)*

Unnecessary Medications, Psychotropic Medications and Medication Regimen Review Critical Element Pathway 10/2022 (CMS-20082 Unnecessary Medications)*

Medication Storage and Labeling 6/2023 (CMS-20089 Medication Storage)

Preadmission Screening and Resident Review Critical Element Pathway 10/2023 (CMS-20090 PASARR)

Extended Survey 8/2024 (CMS-20091 Extended Survey)

Hydration Critical Element Pathway 10/2023 (CMS-20092 Hydration)

Tube Feeding Status Critical Element Pathway 4/2024 (CMS-20093 Tube Feeding)

Positioning, Mobility & Range of Motion (ROM) 10/2023 (CMS-20120 Positioning, Mobility, ROM)

Hospitalization Critical Element Pathway 10/2023 (CMS-20123 Hospitalization)*

Bladder or Bowel Incontinence Critical Element Pathway 10/2023 (CMS-20125 Bladder and Bowel Incontinence)

Accidents Critical Element Pathway 10/2023 (CMS-20127 Accidents)*

Neglect Critical Element Pathway 10/2022 (CMS-201230 Neglect)

Resident Assessment Critical Element Pathway 5/2017 (CMS-20131 Resident Assessment)*

Discharge Critical Element Pathway 10/2023 (CMS-20132 Discharge)*

Dementia Care Critical Element Pathway 10/2023 (CMS-20133 Dementia Care)

Binding Arbitration Agreement Review 5/2023 (CMS-20140 Arbitration)

Updated Critical Element Pathways

In conjunction with the revised Appendix PP and its guidance to surveyors comes a set of revised surveyor tools. These tools can be reviewed here, and once they become effective, we will update our resource documents for your reference.

• Sufficient and Competent Nurse Staffing Review 3/2025
• Respiratory Care Critical Element Pathway 2/2025
• Quality Assurance & Performance Improvement (QAPI) and Quality Assessment & Assurance (QAA) Review 2/2025
• Pain Recognition and Management Critical Element Pathway 2/2025
• Unnecessary Medications, Chemical Restraints/Psychotropic Medications and Medication Regimen Review Critical Element Pathway 2/2025
• Hospitalization Critical Element Pathway 2/2025
• Accidents Critical Element Pathway 2/2025
• Resident Assessment Critical Element Pathway 2/2025
• Discharge Critical Element Pathway 2/2025