On July 13, CMS announced a proposed rule that, for the first time in twenty-five years, would significantly revise the participatory requirements for long term care facilities (LTCFs) to be part of the Medicare and Medicaid programs. The following is a summation of certain sections of the proposed rule, which could most impact providers. Concerned parties will have sixty days from the date that the proposed rule is published in the Federal Register (July 16) to submit comments.
A new section on comprehensive person-centered care planning was created, which would require that an interdisciplinary team make such a plan for each resident within forty-eight hours of their admission. The interdisciplinary team would have to include a nurse aide, member of the food/nutrition services staff, and a social worker, and the plan would need to be discussed with the resident and resident representative (or provide an explanation as to why resident/resident representative participation is not practical). The plan would be required to include instructions on those actions necessary to provide effective quality care for the resident.
Other measures in the proposed rule include:
- A new section establishing LTCF behavioral healthcare requirements, including the condition that staff be able to implement non-pharmacological interventions when appropriate.
- A summary of discharge planning procedures LTCFs would need to be implemented in order to successfully comply with the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.
- A new section outlining the quality assurance and performance improvement requirements for LTCFs, including a rule that would require all facilities to have a system in place for preventing and reporting the spread of communicable diseases.
- A new section on training requirements, which would necessitate training on topics including resident rights and the prevention of resident abuse, neglect, and exploitation. Further, these training requirements would apply not only to LTCF staff, but also to those individuals under contract to provide services to LTCFs.
- The resident rights section has been restructured for increased clarification.
- A new section on facility responsibilities synthesizes existing rules, such as protecting residents and enhancing their quality of life. This section would also require LTCFs to have open visitation similar to hospitals.
- Physician services would be required for a resident’s transfer to a hospital.
- Facilities would be required to undergo assessment to determine the number of staff necessary to provide adequate care at a facility.
- Facilities would need to have an established compliance and ethics program.
- Included in suggested enhancements are drug regimen review requirements that would require LTCF staff to minimize the use of antipsychotic medications.
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