FREE CCP Federal Regulations and Surveys Questions and Answers

Question 1

A state surveyor is reviewing a long-term care facility's medication management system.
The surveyor notes that for PRN psychotropic medications, the prescribing physician has documented rationale for extending the orders beyond 14 days.
However, the documentation only states 'continue for behaviors.' According to CMS regulations (F-Tag 758), why would this be cited as a deficiency?

Accepted Answer

The documentation lacks a specific, targeted condition and evidence of non-pharmacological interventions.

Answer

The documentation must specify the duration for the PRN order.

Answer

PRN psychotropic medications cannot be extended beyond 14 days under any circumstances.

Answer

Only the consultant pharmacist can approve extensions for PRN psychotropic medications.

Question 2

A consultant pharmacist identifies that a resident's attending physician has not responded to a written recommendation regarding a significant medication irregularity for over two weeks. According to federal regulation §483.45(c) (F-Tag 756), what is the pharmacist's required next step?

Accepted Answer

Report the irregularity to the facility's Medical Director and Director of Nursing.

Answer

Discontinue the medication immediately based on their clinical judgment.

Answer

Wait for the next monthly Medication Regimen Review to address it again.

Answer

Contact the resident's family directly to inform them of the situation.

Question 3

During an annual survey, a surveyor is auditing the facility's compliance with DEA regulations for controlled substances. Which of the following scenarios represents a violation of federal DEA requirements for a Long-Term Care Facility (LTCF)?

Accepted Answer

The facility uses a 'chart order' for a Schedule II medication as a valid prescription to be sent to the dispensing pharmacy.

Answer

A nurse acting as an agent of the physician faxes a prescription for a Schedule III medication to the pharmacy.

Answer

The pharmacy partially fills a Schedule II prescription, with the remainder to be dispensed within 60 days.

Answer

A nurse takes a verbal order from a physician for an emergency 72-hour supply of a Schedule II medication.

Question 4

A long-term care facility is cited under F-Tag 757, 'Unnecessary Drugs.' Which of the following situations would most likely lead to this specific citation, based on recent CMS guidance updates?

Accepted Answer

A resident on two different benzodiazepines from the same class without a clear indication for duplicate therapy.

Answer

A resident receiving an antipsychotic PRN for more than 14 days without documented rationale for continuation.

Answer

Failure to attempt a Gradual Dose Reduction (GDR) for a resident on a long-standing antidepressant.

Answer

Administering a hypnotic for sleep without adequate monitoring for side effects like daytime drowsiness.

Question 5

The State Operations Manual (SOM), Appendix PP provides guidance to surveyors for long-term care facilities. What is the primary purpose of this document in the context of a consultant pharmacist's role?

Accepted Answer

To detail the investigative protocols and interpret the regulations surveyors use to assess facility compliance.

Answer

To provide a fee schedule for Medication Regimen Review services.

Answer

To outline the specific clinical guidelines for treating common geriatric conditions.

Answer

To list the required inventory of medications for the facility's emergency drug kit.

Question 6

CMS has placed increasing emphasis on the 'independence' of the consultant pharmacist. What is the primary concern that prompted this regulatory focus?

Accepted Answer

A potential conflict of interest where a pharmacist affiliated with the dispensing pharmacy might favor that pharmacy's products.

Answer

A concern that pharmacists employed by the facility may be pressured to approve cost-cutting measures that harm residents.

Answer

A desire to have pharmacists report survey deficiencies directly to CMS instead of the facility.

Answer

A belief that independent pharmacists have more up-to-date clinical knowledge than those affiliated with a single pharmacy.