F-tags in long-term care: What registered dietitians need to know 

As a dietitian working in long-term care, it is essential to know and understand the F-tags that pertain to food and nutrition services. Becoming familiar with and utilizing F-tags as guidelines of practice, ensures that healthcare facilities are prioritizing the safety and well-being of long-term care residents. 

What are F-tags?

F-tags are part of the Centers for Medicare and Medicaid Services (CMS) annual survey process. Not all F-tags pertain to food and nutrition services. F-tags are a set of guidelines that are used to identify deficiencies or areas of non-compliance with federal regulations in long-term healthcare facilities. In many cases, non-adherence to these guidelines poses a particular risk to the resident. During the annual survey, the facility will be assessed for violations to these tags and a plan of correction will be required to fix the problems as soon as possible.  

Scope and Severity

Once a deficiency is found, it is rated by using another set of guidelines to determine the severity of the violation. This secondary set of guidelines is referred to as scope and severity. Scope and severity assess the severity of the problem and identify the number of residents actually or potentially affected.  

Scope levels are classified as:

• Isolated: Occurs when only one or very few residents are affected, and the occurrence has only happened occasionally or in a very limited number of locations. 
• Pattern: Occurs when more than a few residents have been affected and the incident occurred in more than one place throughout the facility.  
• Widespread: The scope is considered widespread when the violation affects many or most of the residents or has the potential to affect most of the residents and is or could be widespread throughout the entire facility.  

Severity levels are classified as 1 to 4; level 1 being the least severe, level 4 being the most severe.

Level 1 is the least severe, meaning the deficiency has minimal impact on the resident(s). No actual harm occurred or there is only a potential for minimal harm to the resident. Examples include improper hand washing or a kitchen staff member not wearing a hairnet. A plan of correction must be developed to address the concern.  

Level 2 is non-compliance that results in minimal physical, mental, or psychological discomfort to the resident. At level 2, there is the potential for the resident’s safety to be compromised, but it hasn’t actually happened. An example could be not having adequate hydration available. The facility is required to prove a plan of correction has been developed to prevent future harm to residents. 

Level 3 is actual harm to a resident but is not considered immediate jeopardy. An example may be failure to monitor a resident who is at high nutritional risk, which would indicate a broader problem such as lack of policy and procedure or insufficient staffing. The facility is required to take immediate action to address the issue and prevent others from being affected. The facility is now subject to a follow up survey to ensure that proper corrective action was indeed taken.  

Level 4 is the most severe violation and indicates actual harm has occurred. The facility is considered in immediate jeopardy. An example is failure to provide adequate nutrition to a resident, resulting in weight loss and/or malnutrition. When a level 4 violation occurs, the facility is required to take immediate action to address the issue and prevent further residents from being affected.  

F-tags that relate to food and nutrition services

You can find a reference guide to F-tags here. The F-tags that fall under the food and nutrition department are:  

• F800 Provided Diet Needs of Each Resident 
• F801 Qualified Dietary Staff 
• F802 Sufficient Dietary Support Personnel 
• F803 Menus Meet Resident Need and Are Prepared in Advance 
• F804 Nutritive Value, Palatable Appearance, and Preferred Temperature 
• F805 Food Offered in a Form to Meet Individual Needs 
• F806 Resident Allergies, Preferences, and Substitutions  
• F807 Drinks Available to Meet Needs, Preferences, and Hydration 
• F808 Therapeutic Diet Prescribed by Physician  
• F809 Frequency of Meals and Snacks at Bedtime  
• F810 Assistive Devices – Eating Equipment and Utensils  
• F811 Feeding Assistant Training, Supervision, and Residents 
• F812 Food procurement, Storage, Preparation, and Sanitary Serving 
• F813 Personal Food Policy 
• F814 Proper Disposal of Garbage and Refuse 

There are a few other F-tags that dietitians need to be familiar with, they include:  

• F550 Resident’s Rights 
• F636 Comprehensive Assessments 
• F656 Comprehensive Care Plans 
• F686 Skin integrity 
• F692 Nutrition/Hydration Status Maintenance  
• F693 Tube Feeding Management/Restore Eating Skills  
• F867 Quality Assurance and Performance Improvement (QAPI) Program  
• F948 Training for Feeding Assistants  

It is important for dietitians to realize that CMS periodically updates F-tags to ensure that quality of care in long-term care facilities is always paramount. There is no set amount of time in which the updates occur, however, they typically are in response to changes in regulations, new research findings, or emerging issues.   

For this reason, it is crucial for dietitians who work in long-term care facilities to stay up to date with changes by regularly reviewing the State Operations Manual and other bulletins published by CMS. Dietitians can also attend in-person conferences or virtual webinars that discuss changes in regulations and receive continuing education credits. Sounds like a win-win! By staying up to date, you can be assured that best practice procedures are being utilized in your facility.  

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References: 

Scope and Severity Definitions. https://healthapps.state.nj.us/facilities/fsss.htm.  Accessed on 5/2/23. 

Federal Regulatory Groups for Long-term Care. Available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/List-of-Revised-FTags.pdf. Accessed on 5/2/23. 

CMS Federal Regulations. Available at https://www.dcsrd.com/federal-regulations/. Accessed on 5/2/23.