CMS Proposes Changes to Nursing Home Regulations

The Centers for Medicare and Medicaid Services (CMS) has announced a proposed rule, “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” (CMS-3347-P). The proposed rule would remove requirements for participation identified as unnecessary, obsolete, or excessively burdensome on long-term care (LTC) facilities.

According to CMS, the proposed rule would increase facilities’ ability to devote their resources to improving resident care. This would be achieved by the elimination or reduction in the hours and resources that clinicians and providers spend on obsolete and redundant requirements that could impede or divert resources away from the provision of high-quality resident care. Many of the proposed provisions would simplify and/or streamline the Medicare health and safety standards that LTC facilities must meet in order to serve their residents.

Some of the proposed changes are as follows:

Resident Rights (§483.10)

Revise the requirement for facilities to ensure that residents remain informed of the name and specialties of the physician and other primary care professionals responsible for their care and are provided with their contact information.

In addition, propose revisions to the grievance policy requirements. Proposed revisions include clarifying that general feedback may not rise to the level of an official grievance, removing the specific duties required of the grievance official, removing prescriptive requirements related to written grievance decisions, and reducing the amount of time that facilities must retain evidence demonstrating the results of grievances from three years to 18 months.

Admission, Transfer, and Discharge Rights (§483.15)

Revise the requirement for facilities to send discharge notices to the 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.

Nursing Services (§483.35)

Reduce the time frame that LTC facilities are required to retain posted daily nursing staffing data from 18 months to 15 months, or as required by state law.

Behavioral Health (§483.40)

Remove requirements that are duplicative of other LTC requirements in other sections of the regulation and improve clarity.

Pharmacy Services (§483.45)

Remove the existing requirement that Pro re Nata (PRN), or as needed, prescriptions for antipsychotics cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication.

Food and Nutrition Services (§483.60)

Revise the required qualifications for a director of food and nutrition services to provide that those with several years of experience performing as the director of food and nutrition services in a facility could continue to do so; that at a minimum, an individual designated as the director of food and nutrition services would receive frequently scheduled consultations from a qualified dietitian or other clinically qualified nutrition professional and would either have two or more years of experience in the position of a director of food and nutrition services or have completed a minimum course of study in food safety that includes topics integral to managing dietary operations such as, but not limited to, foodborne illness, sanitation procedures, food purchasing/receiving, etc.

Administration (§483.70)

Clarify that data collected under the facility assessment requirement can be utilized to inform policies and procedures for other LTC requirements. In addition, remove duplicative requirements and revise the requirement for the review of the facility assessment from annually to biennially.

Quality Assurance and Performance Improvement (§483.75)

Revise the requirement for facilities to implement a Quality Assurance and Performance Improvement (QAPI) program by removing 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 requirement that the infection preventionist (IP) work at the facility “part-time” or have frequent contact with the infection prevention and control program (IPCP) staff at the facility. Instead require that the facility ensure that the IP has sufficient time at the facility to meet the objectives of its IPCP.

Compliance and Ethics Program (§483.85)

Remove many of the requirements from this section not expressly required by statute. Proposed revisions include removing the requirements for a compliance officer and compliance liaisons and revising the requirement for reviewing the program from annually to biennially.

Physical Environment (§483.90)

Allow older existing LTC facilities to continue to use the 2001 Fire Safety Equivalency System (FSES) mandatory values when determining compliance for containment, extinguishment, and people movement requirements.

Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832