Substantive Reform of Requirements for Long Term Care Facilities

By Baker Newman Noyes August 9, 2015

On July 16, 2015 the Department of Health and Human Services Centers for Medicare and Medicaid Services issued Federal Register CMS-3260-P Reform of Requirements for Long Term Care Facilities via a proposed rule.

Should the release become finalized as is, it would be considered a major rewrite of long term care facilities’ terms and conditions of participation.

Some of the proposed changes have resurfaced from mandates and requirements included in the Affordable Care Act, others are restated from other recent federal issuances speaking to quality and the remaining proposals seek to tighten and define high quality outcome based care practices that lead to better quality programming.

Facilities that have embraced patient centered care models, are adept and familiar with QAPI and manage their operations to reduce re-admissions, restraints, falls and anti-psychotropic medication will see the least amount of impact from the proposed ruling from an implementation stand point. Financially, however, is another story. There is no additional funding for the substantive programming measures being proposed.

A selected summary of the proposed rule changes follows. Please refer to the Federal Register to review the full proposed ruling.

• Resident Rights have been rewritten, including language on “roommate choice.”
• Facility Responsibilities would now extend to protecting the rights of residents and enhancing their quality of life.
• Language discussing Freedom from Abuse, Neglect and Exploitation has been strengthened to limit employment of individuals that have been sanctioned in the past.
• New requirements have been added regarding behavioral health services, including mental and psychosocial illnesses and non-pharmacological intervention.
• There are major improved requirements surrounding transitions of care from one facility to another.
• The prescribing process for ordering diagnostic services, including lab and radiology, has been clarified.
• Facility wide assessments will now be required to ensure that the overall acuity of the resident population is adequately matched by appropriate staffing levels and disciplines, skill sets and competencies.
• Dietary and Nutritional programming would now be required to ensure that meal plans are coordinated with an individual’s particular care plan. Additionally, staffing competencies, training and skill sets must be aligned with the patient population.
• LTC programs must develop and utilize QAPI – Quality Assurance and Performance Incentive programming.
• Nursing Home staff must be properly trained with sufficient competencies while caring for and serving residents with Alzheimer’s, Dementia or Dementia related diseases.

Again, this is a select summary of the proposed rule changes. Please see the full Federal Register link contained in this newsletter for a detailed reading of all of the proposed changes.

If you would like to discuss these matters further, contact your BNN advisor at 1.800.244.7444.