Harmony Healthcare Blog

Medicare and Medicaid Proposed Rule:  Regulatory Changes for Long-Term Care Facilities

Posted by Joyce Sadewicz on Thu, Nov 19, 2015

Edited by Kris Mastrangelo

Centers-for-Medicare-Medicaid-Services-912340-edited.jpgOn July 13, 2015, the Centers for Medicare and Medicaid Services published a Proposed Rule that revises the requirements for participation in Medicare and Medicaid programs for long-term care facilities. This CMS proposal is due to the fact that as CMS states, “The population of nursing homes has changed, and has become more diverse and more clinically complex.” Evidenced based research has been conducted that has provided greater knowledge about resident safety, health outcomes, individual choice and quality assurance and performance improvement. Major changes have not been made to the conditions for participation since 1991 despite the significant changes to service delivery in this setting.

Highlights of the major provisions include:

  • Facility wide assessment to determine the resources necessary to care for the facility's residents competently during day to day operations as well as emergency situations.
  • A competency requirement for determining sufficient nursing and other staff based on the facility assessment. The staff must have the necessary competencies to address the needs of the residents.
  • Comprehensive person centered care planning as part of the pre-admission process, development of a baseline Care Plan within 48 hours of admission and requirements for interdisciplinary team and discharge planning.
  • Comprehensive and specific compliance program requirements in accordance with the Affordable Care Act including key positions such as a Compliance Officer as well as staff training.
  • Requirement related to behavioral health, mental and psychosocial illnesses and non-medication interventions. • Significant changes to pharmacy services.
  • Focus on use of psychotropic medications including limits on PRN medication orders, gradual dose reductions and behavioral interventions.
  • Ordering and receipt of laboratory, radiology and diagnostic services.
  • Extensive requirements for food and nutrition including competencies for staff.
  • In person evaluation of residents by a physician, physician assistant, nurse practitioner or clinical nurse specialist before an unscheduled transfer to a hospital unless emergent.
  • Clarify rehabilitation in relation to PASRR services for mental illness and intellectual disability.
  • Add respiratory therapy services to those services that are identified as specialized rehabilitation services.
  • New health and safety standards for those facilities that provide outpatient services to individuals that do not reside in the facility.
  • Require facilities to develop, implement and maintain an effective, comprehensive and data-driven QAPI program that focuses on systems and outcomes of care as well as quality of life.
  • Requirements regarding expanded and comprehensive infection prevention and control programs.
  • Changes to requirement for physical environment including no more than two residents in a bedroom, requirements for bathroom facilities and smoking areas and safety to comply with federal and state regulations.
  • Extensive requirements regarding training of new and existing staff regarding compliance and ethics, communication, resident's rights and facility responsibilities and abuse, neglect and exploitation. Dementia management and resident abuse prevention training to be included as part of a 12 hour in-service training for nurses aides.

Please see the following link for more information regarding the Proposed Rule.


If you have questions regarding the Proposed Rule, please contact Harmony Healthcare by clicking here or calling our office at (800) 530-4413.

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Tags: Medicare, Medicaid, proposed rule

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