CMS Seeks Input on Revised Requirements of Participation
In a proposed rule related to nursing home payment, the Centers for Medicare and Medicaid Services (CMS) is seeking input on the revised nursing home Requirements of Participation (RoPs). LeadingAge National is collecting member comments, though members may choose to submit comments directly to CMS. Comments should be submitted to LeadingAge by June 19, 2017 or directly to CMS by June 26, 2017. CMS is focusing on the following three areas:
- Grievance and Abuse/Neglect Reporting Processes – CMS states that it is important to maintain residents’ rights to voice grievances but also notes the cost and regulatory burden associated with the extensive expansion of the grievance process in the RoPs rule. CMS specifically mentions the burden and cost of maintaining evidence related to grievances for three years and staffing a grievance official to oversee the grievance process. Accordingly, the agency states:
We are considering areas where we may reduce the burden of these requirements. For example, we may reduce the financial cost associated with maintaining records by reducing the amount of time that they must be retained. We may also consider removing prescriptive language in the requirements regarding the specific duties of the grievance official and allow facilities greater flexibility in how they ensure that grievances are fully addressed. We are reviewing these requirements to determine whether any of the abuse and neglect reporting requirements may be duplicative of state law. In instances where these requirements may potentially be duplicative we may be able to remove them entirely and defer to existing law.
- Quality Assurance and Performance Improvement (QAPI) – The final RoPs rule requires facilities to develop, implement, and maintain an effective comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care, and quality of life. Feedback from stakeholders indicates that the QAPI requirements are too detailed and prescriptive and significantly exceed the QAPI related requirements for other providers. CMS states that it is looking to achieve a balance between specificity and flexibility in the QAPI requirements. The agency notes:
In the areas of program design and scope we could propose to eliminate the detailed requirements regarding how the program must be designed and simply require facilities to design a program that is ongoing, comprehensive, and addresses the full range of care and services provided by the facility. Likewise, in the areas of program feedback, monitoring, and analysis we could eliminate the specific requirements for policies regarding exactly how a facility will determine underlying problems impacting systems in the facility, develop corrective actions, and monitor the effectiveness of its performance. We believe that such revisions will allow facilities greater flexibility in tailoring their QAPI program to fit the needs of their individual facility, eliminating unnecessary burden on facilities, while maintaining consistency with the [statutory] requirements.
- Discharge Notices – Under the final RoPs rule, nursing facilities are required to send discharge notices to the state LTC Ombudsman. CMS states:
We are re-evaluating this requirement to determine if the process is achieving intended objectives to reduce inappropriate involuntary discharges. In addition, we are concerned as to whether LTC Ombudsman have the capacity to receive and review these notices. We are soliciting comment as to whether LTC Ombudsman can handle receiving this material and to what extend (sic) they will use information once received.
Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832