Harmony Healthcare Blog

Long-Term Care Regulations & Policy in the Face of Health Care Reform: 2015 and Beyond

Posted by The Harmony Team on Mon, Dec 29, 2014

There’s no doubt that 2014 introduced a number of substantial regulatory and policy changes to the long-term care industry, many of which are an evolution of what’s to come under the Affordable Care Act.  Health care reform initiatives will undoubtedly continue to drive sweeping changes to providers across the care continuum, particularly as it relates to improving the patient experience, improving health of populations and reducing the cost of health care (otherwise known as “The Triple Aim”).  

As we move into 2015 and beyond, there will be a major paradigm shift and environmental forces will ultimately drive the transformation of health care delivery, quality and financing.  In order to remain viable and succeed under this new model, providers will need to do a number of things, to include:

  • Remain accountable for quality and cost of care
  • Partner with other providers across the continuum
  • Increase efficiency and decrease unwanted variation
  • Accelerate quality improvement and transparency of data
  • Focus on clinical integration strategies
  • Prepare for new payment models (i.e. value-based purchasing)
  • Implement a compliance plan that includes auditing and monitoring systems

As a baseline to integrating health care reform initiatives and strategies noted above, providers must understand and be aware of policy and regulatory initiatives that will drive change in 2015.  The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 and recent updates to the State Operations Manual Interpretive Guidelines for Surveyors and Associated Investigative Protocols are the most significant landmark changes as of recent.

Beginning in January 2015, the Centers for Medicare & Medicaid Services will implement focused survey inspections for a sample of nursing homes nationwide to help verify MDS coding, staffing and quality measure information.  To that end, they will pilot-test quarterly electronic, payroll-based reporting to help calculate quality measures for staff turnover, retention, types of staffing and levels of different types of staffing relayed via the site, with nationwide reporting by all nursing homes expected by the end of fiscal year 2016.  In addition, CMS will revise its scoring methodology used to calculate nursing homes’ five-star ratings for the website. The plan that CMS has laid out also entails change requirements to ensure that states complete nursing home inspections in a timely and accurate manner and maintain user-friendly websites for public viewing; and will increase the number and type of quality measures used on the site. 

On November 26, 2014, new and revised guidance to the State Operations Manual was finally released, which includes changes to over 20 F-Tags, including substantial regulatory updates to advance directives and dementia care standards.  The following is a brief summary of some of the changes, however, the complete update can be found at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R127SOMA.PDF.

F155 §483.10(b)(4) and (8) Advance Directives

  • The resident has the right to refuse treatment, to participate in experimental research, and to formulate an advance directive.

F161 §483.10(c)(7) Assurance of Financial Security

  • The surety bond is not limited to personal needs allowance funds.  Any resident funds that are entrusted to the facility for a resident must be covered by the surely bond, including refundable deposit fees.

F202 §483.12(a)(3) Documentation

  • Clarifies that if a nursing home discharges a resident or retaliates due to an existing resident’s failure to sign or comply with a binding arbitration agreement, the state and region may initiate an enforcement action based on a violation of the rules governing resident discharge and transfer.

F208 §483.12(d)(3) Admissions Policy/Medicaid

  • Prohibition on charging, soliciting, accepting or receiving gifts, money, etc. as a precondition of admission.

F222 §483.13(a) Restraints

  • Clarifies:  Falls do not constitute self-injurious behavior or a medical symptom that warrants the use of a physical restraint.  Although restrains have been traditionally used as a falls prevention approach, they have major, serious drawbacks and can contribute to serious injuries.  There is no evidence that the use of physical restraints, including but not limited to side rails, will prevent or reduce falls. Additionally, falls that occur while a person is physically restrained often result in more severe injuries (e.g., entrapment).

F278 §483.20(l) Certification (Resident Assessment)

  • Addresses use of electronic signatures.

F309 §483.25 Quality of Care – Review of Care and Services for a Resident with Dementia

  • Includes a significant overview and summary of dementia and behavioral health.

F322 - §483.25(g)(1) Naso-Gastric Tubes

  • A resident who has been able to eat enough independently or with assistance is not fed by naso-gastric tube unless the resident’s clinical condition demonstrates that use of a naso-gastric tube was unavoidable.

F329 - §483.25(l) Unnecessary Drugs

  • Antipsychotics; includes updated classes/indications and investigative protocols.

F332/F333 - §483.25(m)(1) and (2) Medication Errors

  • Addresses the facility being free of medication error rates of 5% or greater; residents are free of any significant medication errors.

F371 - §483.35(i) Sanitary Conditions

  • The facility must procure food from sources approved or considered satisfactory by Federal, State or local authorities; and store, prepare, distribute and service food under sanitary conditions.

F388 - §483.40(c)(3) Physician Visits/Physician Delegation of Tasks

  • Clarifies delegation for initial visits and includes an updated chart for delegation of authority to perform visits and sign orders.

F425 - §483.60 Pharmacy Services

  • Clarifies that procedures should identify staff responsible for medication administration ensure adequate supplies, monitor delivery and determine actions when medications are not available.

F428 - §483.35(c) Drug Regimen Review

  • Clarifies the requirement for the Medication Regimen Review (MRR) which applies to each resident, including those who are receiving respite care; are at the end of life or have elected the hospice benefit and are receiving respite care; have an anticipated stay of less than 30 days; or have experienced a change in condition.

F441 - §483.65 Infection Control

  • Addresses single dose/single use medications; handling linens to prevent and control infection transmission.

F514 - §483.75(l) Clinical Records

  • Addresses electronic health records and use of electronic signatures.

If you need help with understanding or interpreting the 2015 regulatory and policy changes, please click here to contact Harmony Healthcare International or call us at (800) 530-4413. 

PEPPER Analysis

Topics: MDS Coding, F-Tags, Health Care Reform, Survey, Long-term Care Regulations, Affordable Care Act

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