The New Survey Process: Be Prepared for Success

Currently, there are different variations of the survey process based on the state where you operate – the Traditional Survey process or a Quality Indicator Survey (QIS).

As you know, the Centers for Medicare and Medicaid Services (CMS) will implement a new survey process nationwide during Requirements of Participation – Phase II (effective Nov. 28, 2017). CMS is working to implement a single survey process that will be used for all LTC providers across the U.S. The Long-Term Care Survey Process (LTCSP) is focused on a person-centered care, outcome-oriented inspection that relies on a case-mix stratified sample of residents to gather information about the facility’s compliance with participation requirements. F Tag numbering with new F Tags and Interpretive Guidance (IG) updates are occurring, in addition to the new LTCSP.

The three parts to the LTCSP includes:

• Initial pool process
• Sample selection
• Investigation

The new LTCSP includes strengths from both the Traditional Survey and QIS, incorporating innovative approaches to help increase effectiveness and efficiency of surveyors while providing as much structure as possible to ensure consistency.


The New LTCSP Will Include:

  1. Automation: Each survey team member uses a tablet or laptop PC throughout the survey process to record findings that are synthesized and organized by new software.
  2. Sample Selection: Determined  by the facility census; 70% of the total sample is MDS pre-selected residents and 30% of the total sample is surveyor-selected residents. Surveyors finalize the sample based on observations, interviews, and a limited record review; Maximum sample size is 35 residents.
  3. Offsite: Each team member independently reviews the Casper 3 report and other facility history information; Review offsite selected residents and their indicators and the facility rates.
  4. Information Needed Upon Entrance: Completed matrix for new admissions over the last 30 days; Facility census number; Alphabetical list of residents; List of residents who smoke and designated smoking times.
  5. Initial Entry to Facility: No formal tour process; Surveyors complete a full observation, interview all interviewable residents, and complete a limited record review for initial pool residents, including, Offsite selected residents, New admissions, Vulnerable residents, Identified Concern that doesn’t fall into one of the above subgroups; 8 hours on average for interviews, observations, and screening.
  6. Survey Structure: Resident sample size is about 20% of facility census; Interview, observation and limited record review care areas are provided for the initial pool process; surveyors can ask the questions as they would like; Surveyors meet to discuss and select sample, may have more concerns than can be added to the sample; may need to prioritize concerns; Investigations are then completed during the remainder of the survey for each sample resident using CE pathways; Facility tasks and closed record reviews are completed during the survey.
  7. Group Interviews: Resident Council Meeting with active members; Includes Resident Council minutes review to identify concerns.

Leadership Considerations:

As facility leaders, now is the time to help your staff understand the new LTCSP in order to adequately prepare. Consider the following:

• Review implementation guidelines and make a plan as your team prepares for the new LTCSP.
• Complete mock surveys to assess readiness.
• Attend education/training sessions to ensure your entire team is prepared. Register for the complimentary Leader’s Forum: Are you Ready for the New Survey Process.
• Keep up-to-date with resources from the CMS website.


Additional resources for LTCSP:

1.  Long Term Care Survey Process (LTCSP) Procedure Guide (effective Nov. 28, 2017)
2.  New Surveyor Training Overview from CMS


Need assistance preparing for the new LTCSP? Contact us today.


Leah Killian-Smith,
Director of QA & Government Services,
Pathway Health