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Keeping up with the regulatory changes and legislative issues is an important responsibility of Activity and Recreation Professionals. Below are some of the regulations and legislative issues that pertain to the leisure profession-there are many more! This page has been created with LTC in mind, however, information regarding other areas of the leisure profession are welcome. Please contact Kim Grandal if you have information you'd like to share.

MDS 3.O News

CMS Survey Swap   Share your recent survey with others and find important downloads.

Below is older legislative news.

Showing Movies in Nursing Facilities and Senior Communities-News Update
April 25, 2011

The motion picture industry has targeted senior living communities in the imposing and collecting of license fees for the showing of their copyrighted (film) materials for years now. It's been an on and off issue-one that wasn't clear until now.

Leading Age and AHCA/NCAL have reached a licensing agreement with the Motion Picture Licensing Corporation (MPLC) to clarify when their members will need a license and pay a licensing fee to show movies to their residents in common areas or via closed circuit TV systems.


The National Alzheimer's Project Act (NAPA)
January, 2011

The National Alzhiemer's Association recently reported the following:

" The National Alzheimer's Project Act (NAPA) is the largest legislative victory in many years for the Alzheimer cause. Over the last several years, the Alzheimer's Association has been the leading voice in urging Congress and the White House to pass the National Alzheimer's Project Act (NAPA). The National Alzheimer's Project Act will create a coordinated national plan to overcome the Alzheimer crisis and will ensure the coordination and evaluation of all national efforts in Alzheimer research, clinical care, institutional, and home- and community-based programs and their outcomes. Alzheimer's advocates were instrumental in moving NAPA through Congress. More than 50,000 e-mails, nearly 10,000 phone calls and more than 1,000 meetings by the Alzheimer's Association and its advocates led us to the historic legislative victory for the Alzheimer community. "

Learn more at

CMS Announces Revisions to Infection Control Interpretive Guidelines for Long-Term Care Facilities-Tag F441
July 23, 2009

CMS recently announced that the following infection control Ftags will be combined into one Ftag 441:

  • Appendix PP/§483.65(a)/Infection Control/Tag F441
  • Appendix PP/§483.65(b)/Preventing Spread of Infection/Tag F441
  • Appendix PP/§483.65(c)/Linens/Tag F441
  • Appendix PP/§483.65(b)/Preventing Spread of Infection/Tag F442
  • Appendix PP/§483.65(b)(2)/Tag F443
  • Appendix PP/§493.65(b)(3)/Tag F444
  • Appendix PP/§493.65(c)/Linens/Tag F445

CMS stated the reason for this change is “to best utilize the surveyors time and resources”. Activity Directors should discuss this revision with the Infection Control liaison in their facilities to ensure compliance.  The effective date for this change is September 30, 2009. Download the memo and infection control update.

FTags-Legislative News
June, 2009

There are a series of F-Tags that have received changes to the interpretive guidance to surveyors. These changes were implemented in response to the results of the April, 2008, symposium, Creating Home in the Nursing Home, co-sponsored by CMS and the Pioneer Network - the focus of this Symposium was person-centered living environments. These changes add clarifications to assist surveyors in determining compliance with these Tags. The regulatory language is unchanged. The changes involve the following F-Tags

  • F172 Access and Visitation
  • F175 Married Couples
  • F241 Dignity
  • F242 Self-Determination and Participation
  • F246 Accommodation of Needs
  • F247 Notice before Room or Roommate Change
  • F252 Safe, Clean, Comfortable and Homelike Environment
  • F461 Private Closet Space
  • F256 Adequate and Comfortable Lighting
  • F463 Resident Call System
  • F371 Sanitary Conditions

Activity Directors should review all of the revised guidance to surveyors to ensure compliance. The guidance of most significance however, is F242 Self Determination and Participation. This guidance clearly states that each resident has the right to make choices in his/her schedule and activities. For example: if a resident is scheduled for a therapy session during the resident’s favorite television show the therapy session should be rescheduled. Another important revised guidance is F371 Sanitary Conditions. This most recent revision clarifies by stating, “All residents have the right to accept food brought to the facility by any visitor(s) for any resident.”

These revisions were implemented June 17, 2009. A final copy of the guidance is available at and ultimately incorporated into Appendix PP of the State Operations Manual. You can download the memo at The memo includes the following:

  • Transmittal Sheet describing changes
  • Advance copy of surveyor guidance revision
  • Guidance Training Instructor Guide outline in Microsoft Word
  • An article on person-centered word usage to accompany F241 Dignity revision

Tag 309 Quality of Care

The interpretive guidelines for F309 were revised to clarify areas such as assessment, care planning, and interventions as well as new investigative protocol for pain management. It is important for Activity Directors to review these changes. Areas of particular interest to Activity Directors include: assessment, care planning, alternative interventions for pain management, potential outcomes of ineffective pain management (decreased activities and quality of life, for example),  and non-pharmacological interventions (music therapy, soothing distracting verbal communication, reading to the resident, activities and recreation). This set of revisions and deletions will become effective on March 1, 2009.

At that time, a final copy of this new guidance will be available at and ultimately incorporated into Appendix PP of the State Operations Manual on the CMS Website. To download an advanced copy (draft) of this FTag, along with training slides, click here.


Star Quality Rating System

On December 18, 2008 CMS issued the Star Quality Rating System for each of the nation’s 15,800 Nursing Homes that participate in Medicare or Medicaid. Facilities are assigned star ratings from a low of one star to a high of five stars based on health inspection surveys, staffing information, and quality of care measures. The ratings are publicly available on the agency’s Nursing Home Compare Web site at CMS plans to post updated Nursing Home Compare Five Star data on the third Thursday of every month. There has been much concern over the accuracy and fairness of this rating system, therefore the AHCA Research team is conducting a detailed research analysis to identify the flaws and weak points of the system.
Click here for additional information on the Rating System.

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