NEW SURVEY PROCESS FOR NOVEMBER 2017

Transcription

1 NEW SURVEY PROCESS FOR NOVEMBER 2017 for clients of: Content developed and presented by: 3030 N. Rocky Point Drive, Suite 240 Tampa, FL

2 NEW SURVEY PROCESS FOR NOVEMBER 2017 Limited Copyright: December 2017, Polaris Group All materials are protected under the copyright laws. The limited copyright allows the purchaser to copy for use but not for distribution. FH62 - Developed by Polaris Group Page 1 of 118

3 NEW SURVEY PROCESS FOR NOVEMBER 2017 POST TEST 1. Phase 2 rules go into effect Nov. 28, a. True b. False 2. The new survey process will be rolled out over time? a. True b. False 3. New Survey process will still include a. Interviews with resident and families b. Resident Counsel Interview c. Investigations using interpretive guidelines and Critical Element pathways d. All of the above 4. Facility tasks include a. Kitchen b. Abuse and Neglect c. Medication Pass d. A and C 5. Which item below is true? a. Infection Control practices are monitored throughout survey. b. Facility Task includes a review of Beneficiary Notices c. Both FH62 - Developed by Polaris Group Page 2 of 118

4 NEW SURVEY PROCESS FOR NOVEMBER 2017 POST TEST ANSWERS 1. Phase 2 rules go into effect Nov. 28, a. True b. False A 2. The new survey process will be rolled out over time? a. True b. False B 3. New Survey process will still include a. Interviews with resident and families D b. Resident Counsel Interview c. Investigations using interpretive guidelines and Critical Element pathways d. All of the above 4. Facility tasks include a. Kitchen b. Abuse and Neglect c. Medication Pass d. A and C D 5. Which item below is true? a. Infection Control practices are monitored throughout survey. b. Facility Task includes a review of Beneficiary Notices c. Both C FH62 - Developed by Polaris Group Page 3 of 118

5 New Long Term Care Survey Process Overview Overview of Regulation Reform F-tag Renumbering New Interpretive Guidance (IG) Current Survey Processes vs. New Survey Process New LTC Survey Process 2 FH62 - Developed by Polaris Group Page 4 of 118

6 Overview of Regulation Reform 3 Overview of Regulation Reform The regulation reform implements a number of pieces of legislation from the Affordable Care Act (ACA) and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, including the following: Quality Assurance and Performance Improvement (QAPI) Reporting suspicion of a crime Increased discharge planning requirements Staff training section 4 FH62 - Developed by Polaris Group Page 5 of 118

7 New Interpretive Guidance (IG) Appendix PP is Final in transmittal Guidance/Guidance/Transmittals/2017-Transmittals- Items/R173SOMA.html?DLPage=1&DLEntries=10&DLSor t=1&dlsortdir=descending Appendix P will not be replaced. Instead the Long Term Care Survey Process (LTCSP) guide will be used. Certification/GuidanceforLawsAndRegulations/Downloads/ LTCSP-Procedure-Guide.pdf 5 Implementation Grid Implementation Date Type of Change Details of Change Phase 1: November 28, 2016 (Implemented) Nursing Home Requirements for Participation New Regulatory Language was uploaded to the Automated Survey Processing Environment (ASPEN) under current F Tags Phase 2: November 28, 2017 F Tag numbering Interpretive Guidance (IG) Implement new survey process New F Tags Updated IG Begin surveying with the new survey process No CMP Sanctions imposed for Phase 2 Rules for one year. Phase 3: November 28, 2019 Requirements that need more time to implement Requirements that need more time to implement 6 FH62 - Developed by Polaris Group Page 6 of 118

8 Phase 2 of LTC Regulations Delay imposition of certain sanctions for 18 months CMP, Discretionary Denial of payments, and Discretionary Termination. Does not apply to statutorily-required Denials of Payments, or Terminations. F-tags include: F655 Baseline F740 Behavioral Health F741 Sufficient/Competent Staff Beh. Health F754 PRN limitations F881 Antibiotic Stewardship ** No delay for F608 Reporting crimes F838 Facility Assess. F865 QAPI Plan F926 Smoking Continue with Dementia Focused Surveys Stopping MDS Focused Surveys 7 Phase 2 of LTC Regulations CMS will freeze Health Inspection Domain on Nov. 29 th for one year. Any surveys that are completed prior to Nov. 29 th under old system will be entered into ASPEN system and could change your rating after that date. ADRs submitted prior to Nov. 29 th, if S/S changes, update may impact 5 Star CMS stated they may remove third survey in the Spring of 2018; meaning your Health Domain score could be re-calculated using last 2 Surveys only. 8 FH62 - Developed by Polaris Group Page 7 of 118

9 F-tag Renumbering 9 F-tag Renumbering The image above is the F-tag Crosswalk showing: The original regulatory grouping and the new associated grouping The original regulation number and the new associated regulation number The original F-tag and the associated new F-tag See attached List of revised F-tag 10 FH62 - Developed by Polaris Group Page 8 of 118

10 New Interpretive Guidance (IG) 11 New Interpretive Guidance (IG) CMS is in the process of updating information for Appendices P and PP. Once the guidance is approved it will be available in the SOM. States should ensure surveyors use the most recent version of the regulation. Advanced copy Appendix PP is available Certification/GuidanceforLawsAndRegulations/Download s/advance-appendix-pp-including-phase-2-.pdf 12 FH62 - Developed by Polaris Group Page 9 of 118

11 Current Survey Processes vs. New Survey Process Information about the survey process and implementation can be found at: and-certification/guidanceforlawsandregulations/nursing- Homes.html Video on new survey process at: 13 Why is CMS Changing the LTC Survey Process? Two different survey processes existed to review for the Requirements of Participation (Traditional and QIS). Surveyors identified opportunities to improve the efficiency and effectiveness of both survey processes. The two processes appeared to identify slightly different quality of care/quality of life issues. CMS set out to build on the best of both the Traditional and QIS processes to establish a single nationwide survey process. 14 FH62 - Developed by Polaris Group Page 10 of 118

12 Goals of New Process Same survey for entire country Strengths from Traditional & QIS New innovative approaches Effective and efficient Resident-centered Process is computer software-based Survey process and software are in testing and development and validation Balance between structure and surveyor autonomy FH62 - Developed by Polaris Group Page 11 of 118

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14 New LTC Survey Process Overview Survey Process 1. Off-site preparation 2. Initial pool process Screen, prioritize, interview/observe/limited record review 3. Sample Selection and concerns identified 4. Facility Tasks and Closed Record Reviews 5. Investigation into identified concerns 6. Facility Tasks and other tasks 7. Decision-making 8. Exit 19 Section I. Offsite Prep 20 FH62 - Developed by Polaris Group Page 13 of 118

15 Offsite Preparation Team Coordinator (TC) completes offsite preparation Repeat deficiencies Results of last Standard survey Complaints Variances/waivers Review CASPER 3 Prior survey history Assigned Units to Surveyors based on facility floor plan 21 Offsite Preparation Team Coordinator (TC) completes offsite preparation Upload MDS data to software for initial sample selection focus on MDS data/qm At least one MDS in last 180 days Excludes stays with only Entry and Discharge Assessments 70% of sample pre-selected Closed record pre-selected 22 FH62 - Developed by Polaris Group Page 14 of 118

16 Section II. Facility Entrance 23 Facility Entrance Team Coordinator (TC) conducts an Entrance Conference Updated Entrance Conference Worksheet Updated facility matrix needed first day Brief visit to the kitchen Surveyors go to assigned areas unit will be assigned for Initial Pool Reviews will start process immediately. 24 FH62 - Developed by Polaris Group Page 15 of 118

17 Entrance Worksheets Review and prepare your Survey information accordingly. Will ask for Facility Assessment Will ask for QAPI Plan FH62 - Developed by Polaris Group Page 16 of 118

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20 Roster Matrix New Admissions within 30 days - complete Matrix upon entrance All other residents within 4 hours 31 Updated Facility Matrix 32 FH62 - Developed by Polaris Group Page 19 of 118

21 Begin practicing filling it out and work with software company FH62 - Developed by Polaris Group Page 20 of 118

22 35 36 FH62 - Developed by Polaris Group Page 21 of 118

23 Section III. Initial Pool Process CMS says on average 8 to 10 hours 37 Initial Pool Process Full Alpha Census and list of all residents admitted within last 30 days is requested immediately upon arrival at Entrance Surveyors go immediately to assigned unit, and may ask for list of residents on unit with admit date. Surveyors will screen all residents in their assigned area will round - observe resident, room, care observations, may introduce themselves maybe up to 10 minutes per resident on unit. 38 FH62 - Developed by Polaris Group Page 22 of 118

24 Initial Pool Process Screening used to identify initial pool - eight residents per surveyor 70% selected offsite- 30% by surveyor based on screen Will see MDS indicators on software Review Roster Matrix for new admissions Offsite selected randomly by computer Vulnerable based on observations New admissions Complaints (up to 5 across all surveyors) Identified concern during screening 39 Initial Pool Process Screening used to identify initial pool eight residents per surveyor If available include (may be spread out across all surveyors) Smokers Receiving dialysis Receiving Hospice Care On ventilator On Transmission-based Precautions Only can remove offsite selected resident from Pool if discharged; may review as a discharged chart. 40 FH62 - Developed by Polaris Group Page 23 of 118

25 Resident Interviews Initial Pool Process Initial Pool 8 per surveyor Formal observations performed around 20 minutes each To perform full interview, if interviewable Interview will have suggested questions not a specific surveyor script Must cover all care areas via observation, interview, or limited chart review if needed Includes Rights, QoL, QoC Target for further investigation or no issue for each resident in initial pool sample 41 Resident Representative/Family Interviews Initial Pool Process Non-interviewable residents Interview someone familiar with the resident s care. Complete at least three during initial pool process or early enough to follow-up on concerns across all Surveyors Sampled residents, if possible, but can chose other residents to find family member to interview. Target to investigate further or no issue for each resident in pool. 42 FH62 - Developed by Polaris Group Page 24 of 118

26 Resident Representative/Family Interviews Initial Pool Process MDS Discrepancies identified for further investigation based on interviews or observations. Using software MDS data; MDS coded as having pain, resident states no pain Resident has contracture; no contracture on MDS 43 Limited Record Review Initial Pool Process Conduct limited record review, based on interviews and observations, are completed including MDS indicators All initial pool residents: Check for advanced directives and confirm specific information from interview or observations New Admissions broad list of high risk medications and hospice May interview staff, if needed but limited Limit Record Review, spend most of time on interviews/observations 44 FH62 - Developed by Polaris Group Page 25 of 118

27 Limited Record Review Initial Pool Process If interview not conducted, or refused, or not available; review certain care areas in record Pressure Ulcers, Dialysis, Infection, Nutrition (including weight loss), Falls last 120 days, Decline in ADLs, Low Risk Bowel/Bladder incontinence, Unplanned hospitalization, Elopement, and/or Change in Condition in last 120 days. Confirm insulin, anticoagulant, and antipsychotic with a diagnosis of Alzheimer s or dementia, and if any PASARR Level 2 (Pre-Admission Screening and Resident Review) 45 Initial Pool Tools Resident Interview Care Areas and Probes Tool Resident Observation Care Areas and Probes Tool Resident Representative Questions Resident Record Review Care Areas See attachments 46 FH62 - Developed by Polaris Group Page 26 of 118

28 Dining First Full Meal Dining observe first full meal Will use CE Pathway CMS Dining Cover all dining rooms and room trays Observe enough to adequately identify concerns If feasible, observe initial pool residents with weight loss If concerns identified, observe another meal 47 Team Meetings Brief meeting at the end of each day Workload Coverage Concern Synchronize/share data (if needed) 48 FH62 - Developed by Polaris Group Page 27 of 118

29 Section IV. Sample Selection for Investigations Around 20% of census Active Residents 49 Sample Size 50 FH62 - Developed by Polaris Group Page 28 of 118

30 Sample Selection Select final sample for further investigation Prioritize using sampling considerations: Replace discharged residents selected offsite with those selected onsite Can replace residents selected offsite with rationale Harm, Substandard Quality of Care if suspected, IJ if identified Abuse Concern and/or Complaint All MDS QM indicator areas if not already included 51 Sample Selection Unnecessary Medication Review System selects five residents for full medication review Use Unnecessary Medication Review Broad range of high-risk medications and adverse consequences Residents may or may not be in investigative sample 52 FH62 - Developed by Polaris Group Page 29 of 118

31 Sample Selection If investigating Abuse Will ask for all allegations of abuse since last survey Will select one for review Will use Abuse CE Pathway 53 Sample Selection Complaint Investigation Only investigate single resident if only one complaint If more than one, then complete on 3 residents 54 FH62 - Developed by Polaris Group Page 30 of 118

32 Sample Selection Even if not identified for investigation include: Hospice Dialysis Vent Transmission-based precautions If need more for sample Residents with most concerns Prior survey issues Areas of facility not represented in sample From Unnecessary Drug Review sample QoL or QoC. 55 Section V. Investigation 56 FH62 - Developed by Polaris Group Page 31 of 118

33 Resident Investigation General Guidelines Conduct investigations for all concerns that warrant further investigation for sampled residents Continuous observations, if required Interview representative, if appropriate, when concerns are identified 57 Investigations Majority of time spent observing and interviewing with relevant review of record to complete investigation Use Appendix PP and critical elements (CE) pathways or guidelines, or Facility Task tools 58 FH62 - Developed by Polaris Group Page 32 of 118

34 Investigations May Investigate by resident Investigate all care areas identified for that resident Useful approach if interviewed/observed/resident representative or reviewing the record May Investigate by care area Access all residents identified for that care area Useful when interviewing staff 59 Investigation Process Begin with record review of MDS, physician orders, and care plan Use probes in CE Pathways If necessary, return to record to confirm information for interviews and observations Observe and interview staff to determine if implement care plan Note and F/U on deviations Concerns with PU or Incontinence perform continuous observations across shifts 60 FH62 - Developed by Polaris Group Page 33 of 118

35 Investigation Process While performing observations consider Sufficient Staff and Competencies For safety and maintaining highest practical functioning Review Facility Assessment if have concerns in a specific care area such as: Hospice, Dialysis, vents Activities, nutrition, behavioral/dementia care Resources therapy and pharmacy 61 Other CE Pathways Used for Investigations CMS Abuse CMS Pressure Ulcers CMS Personal Funds CMS Rehab/Restorative CMS Activities CMS Respiratory Care CMS ADLs CMS Unnecessary Meds CMS Behavioral/Emotional CMS PASARR CMS Urinary Catheter/UTI CMS Extended Survey CMS Communications/sensory CMS Hydration CMS Dental CMS Tube Feeding CMS Dialysis CMS Positioning/Mobility CMS General CMS Bladder/Bowel Incont CMS Hospice/End of life CMS Accidents CMS Nutrition CMS Neglect CMS Pain CMS Resident Assessment CMS Physical Restraints CMS Dementia Care 62 FH62 - Developed by Polaris Group Page 34 of 118

36 Section VI. Ongoing and Other Survey Activities 63 Closed Record Reviews Complete timely during the investigation portion of survey SAMPLE size is 3 closed records At least one of each - Unexpected death, hospitalization, and community discharge last 90 days System selected or discharged resident Will review Notices on discharged Part A residents Use Appendix PP and CE pathways CMS Discharge CMS Hospitalization CMS Death 64 FH62 - Developed by Polaris Group Page 35 of 118

37 Facility Task Investigations Complete any time during investigation Use facility task pathways for each Facility Task Critical Element (CE) compliance decision 1. Sufficient/competent Staff - all 2. Infection Control - all 3. Beneficiary Notices 4. Dining Observations all 5. Medication Storage 6. Medication Administration 7. Kitchen Observations 8. QAA/QAPI 9. Resident Council Group Interview 65 Sufficient and Competent Nurse Staffing Review Is a mandatory task, refer to revised Facility Task Pathway CMS Sufficient and Competent Staff Throughout the survey, consider if staffing concerns can be linked to QoL and QoC concerns Assigned to all surveyors 66 FH62 - Developed by Polaris Group Page 36 of 118

38 Infection Control Throughout survey, all surveyors should observe for infection control; will use CE Pathway CMS Infection Prevention Control & Immunizations Assigned surveyor coordinates a review of influenza and pneumococcal vaccinations Assigned surveyor reviews infection prevention and control, and antibiotic stewardship program Observations by all surveyors 67 SNF Beneficiary Protection Notification Review CMS Beneficiary Notice Will use CE pathway List of residents discharges (home and infacility) provided at Entrance Randomly select three residents Facility completes new worksheet see next slide Review worksheet and notices 68 FH62 - Developed by Polaris Group Page 37 of 118

39 Select Three residents 69 Notices Worksheet for 3 Selected Residents 70 FH62 - Developed by Polaris Group Page 38 of 118

40 Dining Subsequent Meal, if Needed Will observe first meal upon arrival. Second meal observed if concerns noted Use Appendix PP and CE Pathway for Dining CMS Dining Dining task is completed outside any resident specific investigation into nutrition and/or weight loss Assigned to all surveyors 71 Medication Storage & Labeling Medication Storage and labeling Observe half of medication storage rooms and half of medication carts If issues, expand medication room/cart Will use CE Pathway CMS Medication Storage 72 FH62 - Developed by Polaris Group Page 39 of 118

41 Medication Administration Medication Administration Recommend nurse or pharmacist Will use CE Pathway CMS Medication Administration Include sample residents, if opportunity presents itself Reconcile controlled medications, if observed during medication administration Observe different routes, units, and shifts Observe 25 medication opportunities 73 Kitchen Observation In addition to the brief kitchen observation upon entrance, conduct full kitchen investigation Follow Appendix PP and Facility Task Pathway to complete kitchen investigation CMS Kitchen 74 FH62 - Developed by Polaris Group Page 40 of 118

42 QAA/QAPI Will use Facility Task Tool CMS QAA and QAPI Will ask for written QAPI plan upon entrance Will interview staff Done at end of survey 75 Resident Council Meeting Group interview with active members of the council Can invite others try to keep group to no more than 12 Complete early to ensure investigation if concerns identified Will review Council Minutes Refer to updated CE Pathway CMS Resident Council 76 FH62 - Developed by Polaris Group Page 41 of 118

43 Triggered Facility Tasks 77 POLARIS GROUP Strategic Solutions For Healthcare Environment Targeted Review Investigate specific concerns Will use CE Pathway CMS Environment Eliminate redundancy with Life Safety or tags moved to E-tags in Appendix Z Disaster and Emergency Preparedness (Appendix Z) Will not complete review storage of Oxygen, the generator, Disaster planning since part of life safety 78 FH62 - Developed by Polaris Group Page 42 of 118

44 Personal Funds Targeted Review Investigate specific concerns Will use CE Pathway CMS Personal Funds Triggered from concerns with access to funds or quarterly statements 79 Resident Assessment Targeted Review Investigate specific concerns Will use CE Pathway CMS Resident Assessment Triggered if concerns with timeliness of completion or submission or MDS discrepancies 80 FH62 - Developed by Polaris Group Page 43 of 118

45 Section VII. Potential Citations 81 Potential Citations Software calculates potential tags Team makes compliance determination. Compliance decisions reviewed by team Determines Scope and severity (S/S) Includes Psychosocial Outcomes severity guide Conduct exit conference and relay potential areas of deficient practice 82 FH62 - Developed by Polaris Group Page 44 of 118

46 Section VIII. Exit Inform Administrator of observations and preliminary findings Will invite Ombudsman and Resident Council Rep May perform exit conference just for residents 83 LTC Survey Training 84 FH62 - Developed by Polaris Group Page 45 of 118

47 Survey Agency Preparation, continued Implementation of survey process on national level November 28, 2017 Phase 2 of LTC regulations required for implementation November 2017 New CMS approved Basic LTC training material will be released in January 2018 States may need to revise their State Agency training program Information about the survey process and implementation can be found at: Certification/GuidanceforLawsAndRegulations/Nursing-Homes.html 85 Summary Traditional Survey States Much bigger change for these states Going to computer based documentation; facility will need to help provide access and area Still using Roster Matrix for selection QIS States Less of a change overall No structured Interviews anymore Software not driving sample selection 86 FH62 - Developed by Polaris Group Page 46 of 118

48 Summary Read CE Pathways in preparation for survey INTERVIEW residents and families to anticipate what issues may come up INTERVIEW staff to understanding of a resident s care needs permanent staffing will help Review residents with high risk meds Review advance directives Observe staff care for competencies 87 FH62 - Developed by Polaris Group Page 47 of 118

49 Long Term Care Rule F Tag: Job Aid Federal Regulatory Groups for Long Term Care Facilities * Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in Red F540 Definitions Resident Rights F550 *Resident Rights/Exercise of Rights F551 Rights Exercised by Representative F552 Right to be Informed/Make Treatment Decisions F553 Right to Participate in Planning Care F554 Resident Self Admin Meds Clinically Appropriate F555 Right to Choose/Be Informed of Attending Physician F557 Respect, Dignity/Right to have Personal Property F558 *Reasonable Accommodations of Needs/Preferences F559 *Choose/Be Notified of Room/Roommate Change F560 Right to Refuse Certain Transfers F561 *Self Determination F562 Immediate Access to Resident F563 Right to Receive/Deny Visitors F564 Inform of Visitation Rights/Equal Visitation Privileges F565 *Resident/Family Group and Response F566 Right to Perform Facility Services or Refuse F567 Protection/Management of Personal Funds F568 Accounting and Records of Personal Funds F569 Notice and Conveyance of Personal Funds F570 Surety Bond Security of Personal Funds F571 Limitations on Charges to Personal Funds F572 Notice of Rights and Rules F573 Right to Access/Purchase Copies of Records F574 Required Notices and Contact Information F575 Required Postings F576 Right to Forms of Communication with Privacy F577 Right to Survey Results/Advocate Agency Info F578 Request/Refuse/Discontinue Treatment;Formulate Adv Di F579 Posting/Notice of Medicare/Medicaid on Admission F580 Notify of Changes (Injury/Decline/Room, Etc.) F582 Medicaid/Medicare Coverage/Liability Notice F583 Personal Privacy/Confidentiality of Records F584 *Safe/Clean/Comfortable/Homelike Environment F585 Grievances F586 Resident Contact with External Entities Freedom from Abuse, Neglect, and Exploitation F600 *Free from Abuse and Neglect F602 *Free from Misappropriation/Exploitation F603 *Free from Involuntary Seclusion F604 *Right to be Free from Physical Restraints F605 *Right to be Free from Chemical Restraints F606 *Not Employ/Engage Staff with Adverse Actions F607 *Develop/Implement Abuse/Neglect, etc. Policies F608 *Reporting of Reasonable Suspicion of a Crime F609 *Reporting of Alleged Violations F610 *Investigate/Prevent/Correct Alleged Violation Admission, Transfer, and Discharge F620 Admissions Policy F621 Equal Practices Regardless of Payment Source F622 Transfer and Discharge Requirements F623 Notice Requirements Before Transfer/Discharge F624 Preparation for Safe/Orderly Transfer/Discharge F625 Notice of Bed Hold Policy Before/Upon Transfer F626 Perming Residents to Return to Facility Resident Assessments F635 Admission Physician Orders for Immediate Care F636 Comprehensive Assessments & Timing F637 Comprehensive Assmt Aer Significant Change F638 Quarterly Assessment At Least Every 3 Months F639 Maintain 15 Months of Resident Assessments F640 Encoding/Transming Resident Assessment F641 Accuracy of Assessments F642 Coordinaon/Cerficaon of Assessment F644 Coordinaon of PASARR and Assessments F645 PASARR Screening for MD & ID F646 MD/ID Significant Change Notification Comprehensive Resident Centered Care Plans F655 Baseline Care Plan F656 Develop/Implement Comprehensive Care Plan F657 Care Plan Timing and Revision F658 Services Provided Meet Professional Standards F659 Qualified Persons F660 Discharge Planning Process F661 Discharge Summary Quality of Life F675 *Quality of Life F676 *Acvies of Daily Living (ADLs)/ Maintain Abilies F677 *ADL Care Provided for Dependent Residents F678 *Cardio Pulmonary Resuscitaon (CPR) F679 *Acvies Meet Interest/Needs of Each Resident F680 *Qualificaons of Acvity Professional Quality of Care F684 *Quality of Care F685 *Treatment/Devices to Maintain Hearing/Vision F686 *Treatment/Svcs to Prevent/Heal Pressure Ulcers F687 *Foot Care F688 *Increase/Prevent Decrease in ROM/Mobility F689 *Free of Accident Hazards/Supervision/Devices F690 *Bowel/Bladder Inconnence, Catheter, UTI F691 *Colostomy, Urostomy, or Ileostomy Care F692 *Nutrion/Hydraon Status Maintenance F693 *Tube Feeding Management/Restore Eang Skills F694 *Parenteral/IV Fluids F695 *Respiratory/Tracheostomy care and Suconing F696 *Prostheses F697 *Pain Management F698 *Dialysis F699 *{PHASE 3} Trauma Informed Care F700 *Bedrails Physician Services F710 Resident's Care Supervised by a Physician F711 Physician Visits Review Care/Notes/Order F712 Physician Visits Frequency/Timeliness/Alternate NPPs F713 Physician for Emergency Care, Available 24 Hours F714 Physician Delegaon of Tasks to NPP F715 Physician Delegaon to Diean/Therapist Nursing Services F725 Sufficient Nursing Staff F726 Competent Nursing Staff F727 RN 8 Hrs/7 days/wk, Full Time DON F728 Facility Hiring and Use of Nurse F729 Nurse Aide Registry Verificaon, Retraining Report 30: LTC Rule Job Aid Page 1 of 2 Friday, July 14, 2017 FH62 - Developed by Polaris Group Page 48 of 118

50 Federal Regulatory Groups for Long Term Care Facilities * Substandard quality of care = one or more deficiencies with s/s levels of F, H, I, J, K, or L in Red F730 Nurse Aide Perform Review 12Hr/Year In service F731 Waiver Licensed Nurses 24Hr/Day and RN Coverage F732 Posted Nurse Staffing Informaon Behavioral Health Services F740 Behavioral Health Services F741 Sufficient/Competent Staff Behav Health Needs F742 *Treatment/Svc for Mental/Psychosocial Concerns F743 *No Pattern of Behavioral Difficulties Unless Unavoidable F744 *Treatment /Service for Dementia F745 *Provision of Medically Related Social Services Pharmacy Services F755 Pharmacy Svcs/Procedures/Pharmacist/Records F756 Drug Regimen Review, Report Irregular, Act On F757 *Drug Regimen is Free From Unnecessary Drugs F758 *Free from Unnec Psychotropic Meds/PRN Use F759 *Free of Medicaon Error Rate sof 5% or More F760 *Residents Are Free of Significant Med Errors F761 Label/Store Drugs & Biologicals Laboratory, Radiology, and Other Diagnostic Se F770 Laboratory Services F771 Blood Blank and Transfusion Services F772 Lab Services Not Provided On Site F773 Lab Svs Physician Order/Nofy of Results F774 Assist with Transport Arrangements to Lab Svcs F775 Lab Reports in Record LabName/Address F776 Radiology/Other Diagnostic Services F777 Radiology/Diag. Svcs Ordered/Nofy Results F778 Assist with Transport Arrangements to Radiology F779 X Ray/Diagnosc Report in Record Sign/Dated Dental Services F790 Roune/Emergency Dental Services in SNFs F791 Roune/Emergency Dental Services in NFs Food and Nutrition Services F800 Provided Diet Meets Needs of Each Resident F801 Qualified Dietary Staff F802 Sufficient Dietary Support Personnel F803 Menus Meet Res Needs/Prep in Advance/Followed F804 Nutrive Value/Appear,Palatable/Prefer Temp F805 Food in Form to Meet Individual Needs F806 Resident Allergies, Preferences and Substutes F807 Drinks Avail to Meet Needs/Preferences/ Hydraon F808 Therapeuc Diet Prescribed by Physician F809 Frequency of Meals/Snacks at Bedme F810 Assistive Devices Eang Equipment/Utensils F811 Feeding Asst Training/Supervision/Resident F812 Food Procurement, Store/Prepare/Serve Sanitary F813 Personal Food Policy F814 Dispose Garbage & Refuse Properly Specialized Rehabilitative Services F825 Provide/Obtain Specialized Rehab Services F826 Rehab Services Physician Order/Qualified Person Administration F835 Administration F836 License/Comply w/fed/state/local Law/Prof Std F837 Governing Body F838 Facility Assessment F839 Staff Qualifications F840 Use of Outside Resources F841 Responsibilies of Medical Director F842 Resident Records Identifiable Information F843 Transfer Agreement F844 Disclosure of Ownership Requirements F845 Facility closure Administrator F846 Facility closure F849 Hospice Services F850 *Qualifications of Social Worker >120 Beds F851 Payroll Based Journal Quality Assurance and Performance Improvem F865 QAPI Program/Plan, Disclosure/Good Faith Attempt F866 {PHASE 3} QAPI/QAA Data Collecon and Monitoring F867 QAPI/QAA Improvement Acvies F868 QAA Committee Infection Control F880 Infection Prevention & Control F881 Antibiotic Stewardship Program F882 {PHASE 3} Infecon Prevenonist Qualificaons/Role F883 *Influenza and Pneumococcal Immunizaons {PHASE 3} Compliance and Ethics Program F895 {PHASE-3} Compliance and Ethics Program Physical Environment F906 F907 F908 F909 F910 F911 F912 F913 F914 F915 F916 F917 F918 F919 F920 F921 F922 F923 F924 F925 F926 Emergency Electrical Power System Space and Equipment Essenal Equipment, Safe Operang Condion Resident Bed Resident Room Bedroom Number of Residents Bedrooms Measure at Least 80 Square Ft/Resident Bedrooms Have Direct Access to Exit Corridor Bedrooms Assure Full Visual Privacy Resident Room Window Resident Room Floor Above Grade Resident Room Bed/Furniture/Closet Bedrooms Equipped/Near Lavatory/Toilet Resident Call System Requirements for Dining and Activity Rooms Safe/Funconal/Sanitary/ Comfortable Environment Procedures to Ensure Water Availability Ventilation Corridors Have Firmly Secured Handrails Maintains Effecve Pest Control Program Smoking Policies Training Requirements F940 F941 F942 F943 F944 F945 F946 F947 F948 F949 {PHASE 3} Training Requirements General {PHASE 3} Communication Training {PHASE-3} Resident s Rights Training Abuse, Neglect, and Exploitation Training {PHASE 3} QAPI Training {PHASE 3} Infection Control Training {PHASE-3} Compliance and Ethics Training Required In Service Training for Nurse Aides Training for Feeding Assistants {PHASE-3} Behavioral Health Training Report 30: LTC Rule Job Aid Page 2 of 2 Friday, July 14, 2017 FH62 - Developed by Polaris Group Page 49 of 118

51 As of: 06/28/2017 Phase 2 Tag Crosswalk Effective November 28, 2017 Tag # (As of Nov. 28, 2017) SQC Tag? X = Yes Tag Title CFR Regulatory Groupings Tags / Subparts Implemented in Phase 3 Old Tag (Taken from App PP ) RegulationText that was Moved to New Tag F540 Definitions F F550 X Resident Rights/Exercise of Rights (a)(1)(2)(b)(1)(2) Resident Rights F151 F240 F (b)(1)(2) (a)(1)(2) (a)(1) F551 Rights Exercised by Representative (b)(3) (7)(i) (iii) Resident Rights F (b)(3) (7) F552 Right to be Informed/Make Treatment Decisions F553 Right to Participate in Planning Care (c)(2)(3) Resident Rights F554 F555 F557 F558 F559 X X Resident Self Admin Meds Clinically Appropriate Right to Choose/Be Informed of Attending Physician Respect, Dignity/Right to have Personal Property Reasonable Accommodations of Needs/Preferences Choose/Be Notified of Room/Roommate Change (c)(1)(4)(5) Resident Rights F (c)(1)(4)(5) F154 F (c)(7) Resident Rights F (c)(7) (c)(2)(iii) (c)(2)(i)(ii)(iv)(v)(3)(i) (iii) (d)(1) (5) Resident Rights F (d)(1)(2)(4)(5) (e)(2) Resident Rights F (e)(2) (e)(3) Resident Rights F (e)(3) (e)(4) (6) Resident Rights F175 F (e)(4)(5) (e)(6) F560 Right to Refuse Certain Transfers (e)(7)(i) (iii)(8) Resident Rights F (e)(7) (8) F561 X Self Determination (f)(1) (3)(8) Resident Rights F242 F (f)(1) (3) (f)(8) F562 Immediate Access to Resident (f)(4)(i)(A) (G) Resident Rights F (f)(4)(i) F563 Right to Receive/Deny Visitors (f)(4)(ii) (v) Resident Rights F (f)(4)(ii) (v) F564 Inform of Visitation Rights/Equal Visitation Priviledges F565 X Resident/Family Group and Response (f)(5)(i) (iv)(6)(7) Resident Rights F566 F567 F568 F569 F570 Right to Perform Facility Services or Refuse Protection/Management of Personal Funds Accounting and Records of Personal Funds Notice and Conveyance of Personal Funds Surety Bond Security of Personal Funds (f)(4)(vi)(A) (D) Resident Rights F (f)(4)(vi)(A) (D) F243 F (f)(5)(i) (iii)(6)(7) (f)(5)(iv) (f)(9)(i) (iv) Resident Rights F (f)(9) (f)(10)(i)(ii) Resident Rights F158 F (f)(10)(i) (f)(ii) (f)(10)(iii) Resident Rights F (f)(10(iii) (f)(10)(iv)(v) Resident Rights F (f)(iv) (f)(10)(vi) Resident Rights F (f)(10(vi) 1 FH62 - Developed by Polaris Group Page 50 of 118

52 As of: 06/28/2017 Phase 2 Tag Crosswalk Effective November 28, 2017 Tag # (As of Nov. 28, 2017) F571 SQC Tag? X = Yes Tag Title CFR Regulatory Groupings Limitations on Charges to Personal Funds Tags / Subparts Implemented in Phase 3 Old Tag (Taken from App PP ) (f)(11)(i) (iii) Resident Rights F (f)(11)(i) (iii) RegulationText that was Moved to New Tag F572 Notice of Rights and Rules (g)(1)(16) Resident Rights F (g)(1)(16) F573 F574 Right to Access/Purchase Copies of Records Required Notices and Contact Information (g)(2)(i)(ii)(3) Resident Rights F (g)(2)(3) (g)(4)(i) (vi) Resident Rights F (g)(4) F575 Required Postings (g)(5)(i)(ii) Resident Rights F (g)(5) F576 Right to Forms of Communication with Privacy (g)(6) (9) Resident Rights F170 F171 F (g)(8)(i)(9)(i) (iii) (g)(7)(ii)(iii) (g)(6)(7)(i) F577 F578 F579 F580 F582 F583 Right to Survey Results/Advocate Agency Info Request/Refuse/Discontinue Treatment;Formulate Adv Directives Posting/Notice of Medicare/Medicaid on Admission Notify of Changes (Injury/Decline/Room, Etc.) Medicaid/Medicare Coverage/Liability Notice Personal Privacy/Confidentiality of Records (g)(10)(11) Resident Rights F167 F (g)(10)(i)(11) (g)(10)(ii) (c)(6)(8)(g)(12)(i) (v) Resident Rights F (c)(6)(8)(g)(12) (g)(13) Resident Rights F (g)(13) (g)(14)(i) (iv) Resident Rights F (g)(14) (g)(17)(18)(i) (v) Resident Rights F (g)(17) (18) (h)(1) (3)(i)(ii) Resident Rights F164 F (h)(1)(3)(i) (h)(3)(ii) F584 X Safe/Clean/Comfortable/ Homelike Environment (i)(1) (7) Resident Rights F252 F253 F254 F256 F257 F258 F (i)(1)(i)(ii) (i)(2) (i)(3) (i)(5) (i)(6) (i)(7) (i)(4) F585 Grievances (j)(1) (4) Resident Rights F165 F (j)(1) (j)(2 4) F586 Resident Contact with External Entities (k) Resident Rights F (k) F600 X Free from Abuse and Neglect (a)(1) Freedom from Abuse, Neglect, and Exploitation F (a)(1) F602 X Free from Misappropriation/Exploitation Freedom from Abuse, Neglect, and Exploitation F223/ F FH62 - Developed by Polaris Group Page 51 of 118

53 As of: 06/28/2017 Phase 2 Tag Crosswalk Effective November 28, 2017 Tag # (As of Nov. 28, 2017) SQC Tag? X = Yes F603 X Free from Involuntary Seclusion (a)(1) Tag Title CFR Regulatory Groupings Freedom from Abuse, Neglect, and Exploitation Tags / Subparts Implemented in Phase 3 Old Tag (Taken from App PP ) F223 RegulationText that was Moved to New Tag (a)(1) F604 X Right to be Free from Physical Restraints (e)(1) (a)(2) Resident Rights Freedom from Abuse, Neglect, and Exploitation F221 F (e )(1), (a)(2) (e )(1), (a)(2) F605 X Right to be Free from Chemical Restraints (e)(1) (a)(2) Resident Rights Freedom from Abuse, Neglect, and Exploitation F (e )(1), (a)(2) F606 X Not Employ/Engage Staff with Adverse Actions (a)(3)(4) Freedom from Abuse, Neglect, and Exploitation F (a)(3)(4) F607 X Develop/Implement Abuse/Neglect, etc. Policies (b)(1) (4) Freedom from Abuse, Neglect, and Exploitation (b)(4) Phase 3 Will not be in ASPEN until Phase 3 F (b)(1) (4) F608 X Reporting of Reasonable Suspicion of a Crime (b)(5)(i) (iii) Freedom from Abuse, Neglect, and Exploitation No Associated Tag F609 X Reporting of Alleged Violations (c)(1)(4) Freedom from Abuse, Neglect, and Exploitation F (c)(1)(4) F610 X Investigate/Prevent/Correct Alleged Violation (c)(2) (4) Freedom from Abuse, Neglect, and Exploitation F (c)(2) (4) F620 Admissions Policy (a)(1) (7) F621 Equal Practices Regardless of Payment Source (b)(1) (3)(c)(9) F622 Transfer and Discharge Requirements (c)(1)(i)(ii)(2)(i) (iii) F623 F624 F625 F626 F635 Notice Requirements Before Transfer/Discharge Preparation for Safe/Orderly Transfer/Discharge Notice of Bed Hold Policy Before/Upon Transfer Permitting Residents to Return to Facility Admission Physician Orders for Immediate Care (c)(3) (6)(8) (c)(7) (d)(1)(2) (e)(1)(2) Admission, Transfer, and Discharge Admission, Transfer, and Discharge Admission, Transfer, and Discharge Admission, Transfer, and Discharge Admission, Transfer, and Discharge Admission, Transfer, and Discharge Admission, Transfer, and Discharge F208 F207 F201 F202 F203 F204 F205 F (a)(1) (7) (b)(1) (3)(c)(9) (c)(1)(i)(ii) (c)(2)(i) (iii) (c)(3) (6)(8) (c)(7) (d)(1)(i) (iv)(2) (e)(1)(2) (a) Resident Assessments F (a) 3 FH62 - Developed by Polaris Group Page 52 of 118

54 As of: 06/28/2017 Phase 2 Tag Crosswalk Effective November 28, 2017 Tag # (As of Nov. 28, 2017) SQC Tag? X = Yes Tag Title CFR Regulatory Groupings Tags / Subparts Implemented in Phase 3 Old Tag (Taken from App PP ) RegulationText that was Moved to New Tag F636 Comprehensive Assessments & Timing (b)(1)(2)(i)(iii) Resident Assessments F272 F273 F (b)(1) (b)(2)(i) (b)(2)(iii) F637 F638 F639 F640 Comprehensive Assmt After Significant Change Quarterly Assessment At Least Every 3 Months Maintain 15 Months of Resident Assessments Encoding/Transmitting Resident Assessment (b)(2)(ii) Resident Assessments F (b)(2)(ii) (c) Resident Assessments F (c ) (d) Resident Assessments F279 F (d) (d) (f)(1) (4) Resident Assessments F (f)(1) (4) F641 Accuracy of Assessments (g) Resident Assessments F (g) F642 F644 Coordination/Certification of Assessment Coordination of PASARR and Assessments (h) (j) Resident Assessments F (h) (j) (e)(1)(2) Resident Assessments F (e) F645 PASARR Screening for MD & ID (k)(1) (3) Resident Assessments F (k)(1) (3) F646 MD/ID Significant Change Notification (k)(4) Resident Assessments F (k)(4) F655 Baseline Care Plan (a)(1) (3) Comprehensive Resident Centered Care Plans No Associated Tag F656 Develop/Implement Comprehensive Care Plan (b)(1) Comprehensive Resident Centered Care Plans F (b)(1) F657 Care Plan Timing and Revision (b)(2)(i) (iii) Comprehensive Resident Centered Care Plans F (b)(2)(i) (iii) F658 Services Provided Meet Professional Standards (b)(3)(i) Comprehensive Resident Centered Care Plans F (b)(3)(i) F659 Qualified Persons (b)(3)(ii)(iii) Comprehensive Resident Centered Care Plans (b)(iii) Phase 3 Will not be in ASPEN until Phase 3 F (b)(3)(ii) F660 Discharge Planning Process (c)(1)(i) (ix) Comprehensive Resident Centered Care Plans F (c)(1)(i) (ix) F661 Discharge Summary (c)(2)(i) (iv) Comprehensive Resident Centered Care Plans F283 F (c)(2)(i) (iii) (c)(2)(iv) 4 FH62 - Developed by Polaris Group Page 53 of 118

55 As of: 06/28/2017 Phase 2 Tag Crosswalk Effective November 28, 2017 Tag # (As of Nov. 28, 2017) SQC Tag? X = Yes Tag Title CFR Regulatory Groupings Tags / Subparts Implemented in Phase 3 Old Tag (Taken from App PP ) RegulationText that was Moved to New Tag F675 X Quality of Life Quality of Life F F676 F677 F678 F679 F680 X X X X X Activities of Daily Living (ADLs)/ Maintain Abilities ADL Care Provided for Dependent Residents Cardio Pulmonary Resuscitation (CPR) Activities Meet Interest/Needs of Each Resident Qualifications of Activity Professional (a)(1)(b)(1) (5)(i) (iii) Quality of Life F310 F (a)(b)(1) (5)(i) (iii) (a)(1) (a)(2) Quality of Life F (a)(2) (a)(3) Quality of Life F (a)(3) (c)(1) Quality of Life F (c)(1) (c)(2)(i)(ii)(A) (D) Quality of Life F (c)(2)(i)(ii)(A) (D) F684 X Quality of Care Quality of Care F F685 X Treatment/Devices to Maintain Hearing/Vision (a)(1)(2) Quality of Care F (a)(1) (2) F686 X Treatment/Svcs to Prevent/Heal Pressure Ulcers (b)(1)(i)(ii) Quality of Care F (b)(1)(i)(ii) F687 X Foot Care (b)(2)(i)(ii) Quality of Care F (b)(2)(i)(ii) F688 F689 F690 F691 F692 X X X X X Increase/Prevent Decrease in ROM/Mobility Free of Accident Hazards/Supervision/Devices Bowel/Bladder Incontinence, Catheter, UTI Colostomy, Urostomy, or Ileostomy Care Nutrition/Hydration Status Maintenance (c)(1) (3) Quality of Care F317 F (c)(1) (c)(2)(3) (d)(1)(2) Quality of Care F (d)(1)(2) (e)(1) (3) Quality of Care F (e)(1) (3) (f) Quality of Care F (f) (g)(1) (3) Quality of Care F325 F (g)(1)(3) (g)(2) F693 X Tube Feeding Management/Restore Eating Skills (g)(4)(5) Quality of Care F (g)(4)(5) F694 X Parenteral/IV Fluids (h) Quality of Care F (h) F695 X Respiratory/Tracheostomy care and Suctioning (i) Quality of Care F (i) F696 X Prostheses (j) Quality of Care F (j) F697 X Pain Management (k) Quality of Care F (k) F698 X Dialysis (l) Quality of Care F (l) 5 FH62 - Developed by Polaris Group Page 54 of 118

56 As of: 06/28/2017 Phase 2 Tag Crosswalk Effective November 28, 2017 Tag # (As of Nov. 28, 2017) SQC Tag? X = Yes Tag Title CFR Regulatory Groupings F699 X Trauma Informed Care (m) Quality of Care F700 X Bedrails (n)(1) (4) Quality of Care F710 F711 F712 F713 F714 F715 Resident's Care Supervised by a Physician Physician Visits Review Care/Notes/Order Physician Visits Frequency/Timeliness/Alternate NPPs Physician for Emergency Care, Available 24 Hours Physician Delegation of Tasks to NPP Physician Delegation to Dietitian/Therapist Tags / Subparts Implemented in Phase 3 Entire tag Phase 3 Will not be in ASPEN until Phase 3 Old Tag (Taken from App PP ) F323 F461 RegulationText that was Moved to New Tag No Associated Tag (n)(1) (3) (n)(4) (a)(1)(2) Physician Services F (a)(1)(2) (b)(1) (3) Physician Services F (b)(1) (3) (c)(1) (4) Physician Services F387 F (c)(1)(2) (c)(3)(4) (d) Physician Services F (d) (e)(1)(4)(f) Physician Services F (e)(1)(4)(f) (e)(2)(3) Physician Services F (e)(2(3) F725 Sufficient Nursing Staff (a)(1)(2) Nursing Services F (a)(1)(2) F726 Competent Nursing Staff (a)(3)(4)(c) Nursing Services F353 F (a)(3)(4) (c) F727 RN 8 Hrs/7 days/wk, Full Time DON (b)(1) (3) Nursing Services F (b)(1) (3) F728 F729 F730 F731 F732 Facility Hiring and Use of Nurse Aide Nurse Aide Registry Verification, Retraining Nurse Aide Perform Review 12 Hr/Year In service Waiver Licensed Nurses 24 Hr/Day and RN Coverage Posted Nurse Staffing Information F740 Behavioral Health Services F741 F742 F743 X X Sufficient/Competent Staff Behav Health Needs Treatment/Svc for Mental/Psychosocial Concerns No Pattern of Behavioral Difficulties UnlessUnavoidable (d)(1) (3) Nursing Services F494 F (d)(1)(2) (d)(3) (d)(4) (6) Nursing Services F (d)(4) (6) (d)(7) Nursing Services F (d)(7) (e)(1) (7)(f)(1)(2) Nursing Services F (e)(1) (7)(f)(1)(2) (g)(1) (4) Nursing Services F (g)(1) (4) (a)(1)(2) (b)(1) (b)(2) F744 X Treatment /Service for Dementia (b)(3) Behavioral Health Services Behavioral Health Services Behavioral Health Services Behavioral Health Services Behavioral Health Services F319 F320 F309 No Associated Tag No Associated Tag (b)(1) (b)(2) (b)(3) 6 FH62 - Developed by Polaris Group Page 55 of 118

57 As of: 06/28/2017 Phase 2 Tag Crosswalk Effective November 28, 2017 Tag # (As of Nov. 28, 2017) F745 F755 F756 F757 F758 F759 F760 F761 SQC Tag? X = Yes X X X X X Tag Title CFR Regulatory Groupings Provision of Medically Related Social Services Pharmacy Svcs/Procedures/Pharmacist /Records Drug Regimen Review, Report Irregular, Act On Drug Regimen is Free From Unnecessary Drugs Free from Unnec Psychotropic Meds/PRN Use Free of Medication Error Rates of 5% or More Residents Are Free of Significant Med Errors Label/Store Drugs & Biologicals (d) (a)(b)(1) (3) Behavioral Health Services Pharmacy Services Tags / Subparts Implemented in Phase 3 Old Tag (Taken from App PP ) F250 F425 F431 RegulationText that was Moved to New Tag (d) (a)(b)(1) (b)(2)(3) (c)(1)(2)(4)(5) Pharmacy Services F (c)(1)(2)(4)(5) (d)(1) (6) Pharmacy Services F (d) (c)(3)(e)(1) (5) Pharmacy Services F329 F (e)(1) (5) (c)(3) (f)(1) Pharmacy Services F (f)(1) (f)(2) Pharmacy Services F (f)(2) (g)(h)(1)(2) Pharmacy Services F (g) (h) F770 Laboratory Services (a)(1)(i) Laboratory, Radiology, and Other Diagnostic Services F502 F (a)(1) (a)(i) F771 Blood Blank and Transfusion Services (a)(1)(ii) Laboratory, Radiology, and Other Diagnostic Services F502 F (a)(1) (a)(ii) F772 Lab Services Not Provided On Site (a)(1)(iv) Laboratory, Radiology, and Other Diagnostic Services F (a)(iv) F773 Lab Svs Physician Order/Notify of Results (a)(2)(i)(ii) Laboratory, Radiology, and Other Diagnostic Services F504 F (a)(2)(i) (a)(2)(ii) F774 Assist with Transport Arrangements to Lab Svcs (a)(2)(iii) Laboratory, Radiology, and Other Diagnostic Services F (a)(2)(iii) F775 Lab Reports in Record Lab Name/Address (a)(2)(iv) Laboratory, Radiology, and Other Diagnostic Services F (a)(2)(iv) F776 Radiology/Other Diagnostic Services (b)(1)(i)(ii) Laboratory, Radiology, and Other Diagnostic Services F508 F (b)(1) (b)(i)(ii) F777 Radiology/Diag. Svcs Ordered/Notify Results (b)(2)(i)(ii) Laboratory, Radiology, and Other Diagnostic Services F510 F (b(2)(i) (b)(2)(ii) F778 Assist with Transport Arrangements to Radiology (b)(2)(iii) Laboratory, Radiology, and Other Diagnostic Services F (b)(2)(iii) 7 FH62 - Developed by Polaris Group Page 56 of 118