Published July 17, 2019

Proposed Rule Requirements for Long-Term Care Facilities: Changes may be coming!

On July 16, 2019, CMS announced a proposed rule, “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” (CMS-3347-P) that could bring some welcomed updates to a number of Phase 1 & 2 items as well as those taking effect November 28, 2019 with Phase 3.

Full details can be accessed through the below link but here is a summary of the proposal:

• Grievance policy requirements (§483.10)  – clarify that general feedback may not rise to the level of an official grievance, remove the specific duties required of the grievance official, remove prescriptive requirements related to written grievance decisions, and reduce the amount of time that facilities must retain evidence demonstrating the results of grievances from 3 years to 18 months.
• Admission, Transfer and Discharge Rights (§483.15) – revise the requirement for facilities to send discharge notices to State LTC Ombudsman by applying this requirement to “facility-initiated involuntary transfers and discharges” only.
• Quality of Care (§483.25) – modify requirements to focus on the appropriate “use” of bed rails and eliminate references to the “installation” of bed rails. These revisions would provide clarity and address stakeholder concerns regarding the purchase of beds with bed rails already in place with no practical means of removal.
• Nursing Services (§483.35) – reduce the timeframe that LTC facilities are required to retain posted daily nursing staffing data from 18 months to 15 months, or as required by state law.
• Pharmacy Services (§483.45) – remove the existing requirement that PRN, or as needed, prescriptions for anti-psychotics cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication. This proposed revision would increase flexibility by allowing each facility to allow for PRN orders of all psychotropic medications to be extended beyond 14 days if the attending physician or prescribing practitioner believes it appropriate and documents his or her rationale in the resident’s medical record and indicates the duration for the PRN order.
• Food and Nutrition Services (§483.60) – increase flexibility by providing that those who have performed as the director of food and nutrition services for a minimum of two years by allowing them to continue doing so without obtaining additional certification. Newly hired directors of food and nutrition services or those with less than two years of experience would need to complete, at a minimum, a course in food safety and management.
• Administration (§483.70) – revise the requirement for the review of the facility assessment from annually to biennially.
• QAPI (§483.75) – remove prescriptive requirements to allow facilities greater flexibility in tailoring their QAPI program to the specific needs of their individual facility.
• Infection Control (§483.80) – remove the “part-time” IP requirement and change to sufficient time at the facility.
• Compliance and Ethics Program (§483.85) – remove the requirements for a compliance officer and compliance liaisons and reviewing the program from annually to biennially.
• Physical Environment (§483.90) – revise the requirements that newly constructed, re-constructed, or newly certified facilities accommodate no more than two residents in a bedroom and equip each resident room with its own bathroom that has a commode and sink. This would apply to newly constructed facilities and newly certified facilities that have never previously been a nursing home.
• 42 CFR part 483 subpart B – update Informal Dispute Resolution (and independent process) by adding timeframes on process, and increased provider transparency.

CMS also proposes revisions to the Phase 3 provisions, that if approved, would have an impact on provisions that fall into three primary areas- (1) designation and training of the infection preventionist (§483.80), QAPI (§483.75), and compliance and ethics program (§483.85). CMS proposes to delay implementation of some of these Phase 3 provisions until 1 year following the effective date of this regulation. CMS does not propose to delay those requirements related to the infection preventionist at §483.80(b)(1) through (4), (c) and §483.75(g)(1)(iv).

CMS encourages provider feedback on the proposed rule and is accepting comments until September 16, 2019. Comments may be submitted electronically  through the Federal Registry here: https://www.federalregister.gov/documents/2019/07/18/2019-14946/medicare-and-medicaid-programs-requirements-for-long-term-care-facilities-regulatory-provisions-to

Amy Lee, RN, MSN, CRRN, QCP
President/CEO