By: Attorney Rachel Trafton

In order for skilled nursing facilities and nursing facilities to receive payment under the Medicare or Medicaid programs, the facility must meet certain requirements. The Centers for Medicare and Medicaid Services (CMS) has recently released a final rule revising these requirements. This is the first comprehensive update to long-term care facility requirements since 1991.

CMS released the final rule totaling over 700 pages in September. The new regulations become effective in three stages beginning on November 28, 2016. According to CMS, the changes are part of its ongoing commitment for Medicare and Medicaid facilities to become more resident-centered. There are many additions and revisions, such as enhancing the quality of care and quality of life standard for each resident, adding competency and training requirements for staff, and updating the facility’s infection prevention and control program. This article focuses on three notable updates.

1. Shifting to Person-Centered Care

Person-centered care is defined in the regulations as “focusing on the resident as the locus of control and supporting the resident in making their own choices and having control over their daily lives.” CMS added an entirely new section entitled “Comprehensive Person-Centered Care Planning.” It will require facilities to develop and implement a baseline care plan for a new resident within 48 hours of admission. The care planning process calls for greater resident involvement and participation, as well as requiring both a certified nursing aide and a member of the food and nutrition services staff to participate in the care planning process. This section also requires a discharge planning process that focuses on the resident’s discharge goals and prepares residents for effective transitions. By requiring these processes, the facility learns more about the resident as a person, provides greater support for the resident and family members, and gives residents an increased voice and control over their care.

2. Requiring Grievance Policies

In an effort to strengthen resident rights, the new regulations require facilities to have a grievance policy and a grievance official to oversee that grievance process. All allegations of abusive conduct must be investigated and reported. Complaints must receive a response in writing which includes the steps taken to investigate the complaint, a summary of the findings or conclusions, a statement as to whether the grievance was confirmed or not confirmed, and the action taken or to be taken by the facility.

3. Improving Involuntary Transfer-Discharge Procedures

Involuntary transfer-discharge can occur when a resident is unable to pay the facility for his or her care, the resident threatens the safety of others, or the facility is unable to meet the needs of a resident. The new regulations clarify that “safety of others” is limited to endangerment due to the clinical or behavioral status of the resident, and the regulations reaffirm that there is no non-payment if the resident is waiting on a payment decision from a third-party payor, such as Medicaid. CMS provided further protection from transfer-discharge if an appeal is pending. Additionally, if the facility cannot meet the resident’s needs, the transfer-discharge report must include the specific resident needs that cannot be met, how the facility attempted to meet the needs, and what services are available at the receiving facility to meet the needs.

These procedures will require notice of transfer-discharge to be sent to the long-term care ombudsman program as well as documentation to the new provider for an easier transition. Finally, a facility will be required to follow these same transfer-discharge procedures in the event the facility has claimed a hospitalized resident cannot return to its facility.

For the full rule and explanatory material please visit https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-23503.pdf or visit www.cms.gov for more information.