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Even though the changes are only proposed, they are vast enough that nursing facilities should understand them and have a plan for implementation.

Navigating health reform

Proposed Changes Aim to Improve Safety and Quality of Long-Term Care Facilities

  • 8/24/2015

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule to reform long-term care facilities in Medicare and Medicaid programs. The changes are part of CMS’s efforts to improve patient safety and the quality of health care. Even though these changes are proposed, your organization should have a plan to adapt to them.

CMS is seeking comments on the scope and type of changes included in the proposed rule by September 14, 2015.

The changes include new sections and revisions to existing Affordable Care Act regulations, including compliance and ethics programs, quality assurance and performance improvement (QAPI), and reporting potential crime requirements.

CMS is seeking comments on the scope and type of changes included in the proposed rule by September 14, 2015. The long-term care industry as a whole plans on responding to these changes through the various associations, so communicate with your local association regarding any questions or concerns.

New sections

Facility responsibilities

This section focused on bringing together many of the nursing facility’s responsibilities currently dispersed throughout the existing regulations, including protecting the rights of residents and enhancing a resident’s quality of life. Changes include new requirements to establish open visitation.

Comprehensive person-centered care planning

CMS’s proposal includes the following changes:

  • Facilities must develop a baseline care plan for each resident within 48 hours of their admission, which includes the instructions for effective and person-centered care that meets professional standards.
  • Nursing facilities must include as part of a resident’s care plan any specialized or rehabilitation services based on Preadmission Screening and Resident Review (PASARR) recommendations. If a facility disagrees with the PASARR findings, it must indicate why in the resident’s medical record.
  • A nurse aide, a member of the food and nutrition services staff, and a social worker must be included in the interdisciplinary team that develops a resident’s comprehensive care plan. Facilities must also note in the medical record if the resident and their representative should not be involved in the development of their care plan.
  • Long-term care (LTC) facilities must implement discharge planning requirements mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act . The act requires that certain providers, including long-term care facilities, take into account quality, resource use, and other measures to inform and assist with the discharge planning process, while also accounting for the treatment preferences and goals of care of residents.

Laboratory, radiology, and other diagnostic services

The following clarifications were added:

  • Ordering services — a physician assistant, nurse practitioner, or clinical nurse specialist may order laboratory, radiology, and other diagnostic services for a resident in accordance with state law, including scope of practice laws.
  • Laboratory services — the ordering physician, physician assistant, nurse practitioner, or clinical nurse specialist must be notified of abnormal laboratory results when they fall outside clinical reference ranges, in accordance with facility policies and procedures or per the physician’s, physician assistant’s, nurse practitioner’s, or clinical nurse specialist’s order.

Quality assurance and performance improvement

All LTC facilities must develop, implement, and maintain an effective comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care, and quality of life.

Compliance and ethics program

The operating organization for each facility must have an operational compliance and ethics program that establishes written compliance and ethics standards, policies, and procedures that are capable of reducing the prospect of criminal, civil, and administrative violations in accordance with section 1128I(b) of the Social Security Act.

Training requirements

Facilities must develop, implement, and maintain an effective training program for all new and existing staff, individuals providing services under a contractual arrangement, and volunteers, consistent with their expected roles. Training topics must include:

  • Communication
  • Resident rights and facility responsibilities
  • Abuse, neglect, and exploitation
  • QAPI and infection control
  • Compliance and ethics
  • In-service training for nurse aides
  • Behavior health training

Behavioral health services

The necessary behavioral health care and services must be given to residents in accordance with their comprehensive assessment and plan of care.

Existing Sections

Resident rights

This section retains all existing residents’ rights and improves the language and organization of the provisions, clarifies aspects of the regulation where necessary, and updates provisions to include advances such as electronic communication.

Freedom from abuse, neglect, and exploitation

Formerly titled “resident behavior and facility practices,” this section specifies that facilities cannot employ individuals who have had a disciplinary action taken against their professional license by a state licensure body due to a finding of abuse, neglect, mistreatment of residents, or misappropriation of property. It also requires facilities to develop and implement written policies and procedures that prohibit and prevent abuse, neglect, and mistreatment of residents or misappropriation of their property.

Resident assessments

The changes clarify what constitutes appropriate coordination of a resident’s assessment with the PASARR program under Medicaid.

Quality of care and quality of life

The changes clarify that quality of care and quality of life are overarching principles in the delivery of care to nursing home residents and should be applied to every service, including:

  • Activities of daily living
  • Director of activities qualifications
  • Special need issues
  • Re-designation of requirements

Infection control

Facilities must have a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals. Facilities must review and update this process annually, and designate an Infection Prevention and Control Officer (IPCO) to serve as a member of the facility’s quality assessment and assurance committee.

Other sections that have updates and clarifications include:

  • Physician services
  • Nursing services
  • Pharmacy services
  • Dental services
  • Food and nutrition services
  • Specialized rehabilitative services
  • Physical environment
  • Outpatient rehabilitative services
  • Administration

How we can help

Make sure to communicate your concerns regarding these proposed rules to your local long-term care association before September 14. CLA can help you update internal policies and procedures manuals to meet these requirements, as well as develop and update compliance and ethics programs. We can also assist you in training for your staff and work with governance and management to understand the roles and responsibilities that come along with the proposed rules.