On July 16, 2019, Centers for Medicare and Medicaid Services (CMS) released proposed changes to requirements for Long Term Care facilities.

Comments are due September 16, 2019.

CMS proposes changes to Long Term Care (LTC) facility requirements and estimates administrative cost savings of $616 million annually over five years. As part of the Administration’s Patients Over Paperwork initiative, these savings will come from reductions and reforms in requirements for:

• Information collection and retention
• Facility construction, and
• Survey and enforcement regulations

Proposed changes include reduction in administrative requirements regarding:

• Resident rights
• Admission, transfer and discharge notices to State LTC Ombudsman
• Timeframes for retaining facility-stored date (i.e. nurse staffing data, evidence demonstrating results from resident grievances, etc.)
• Credentialing for the director of food and nutrition services
• Compliance and ethics programs

CMS also proposes to:

• Remove the requirement for PRN prescriptions of psychotropic medications to be renewed beyond the 14-day limit by an attending physician if the rationale and duration is initially indicated in the PRN order
• Streamline aspects of the facility assessment and Quality Assurance Improvement Program (QAPI) requirements
• Accept waivers from existing facilities that previously met FSES requirements for compliance with the Life Safety Code
• Apply requirements for number of residents per rooms and bathrooms only to newly constructed and certified LTC facilities
• Eliminate the requirement to submit a written waiver of hearing rights for facilities facing civil money penalties
  • All facilities that do not file a waiver would automatically receive the 35% reduction in penalty amount.

Additionally, CMS finalizes a rule that updates the requirements that nursing homes must meet to use binding arbitration agreements.  In 2017, after directing state officials not to enforce its 2016 final rule on long-term care arbitration agreements, CMS issued a new proposed rule which would have allowed for such agreements between long-term care facilities and residents, effectively prohibiting litigation against the facility. Today, CMS finalizes that rule, but without allowing facilities to make such an agreement mandatory as a condition of admission. In addition, residents must be clearly apprised of their right not to sign such an agreement and have 30 days to revoke their acceptance of one. The rule is effective beginning September 16, 2019.

x

x

x