Updated CMS Matrix Form & Instructions

Lisa Volk and Jackie Pappalardi in Clinical & Quality

CMS – The (CMS- 802) Matrix Form and Instructions for Providers has now been updated to include SARS-CoV-2 suspected or confirmed-COVID. The Matrix is used to identify pertinent care categories for: 1) newly admitted residents in the last 30 days who are still residing in the facility, and 2) all other residents. All information entered into the form should be verified by a staff member knowledgeable about the resident population. Information must be reflective of all residents as of the day of survey

See updated instructions and form attached

NYSHFA/NYSCAL CONTACTS:

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16