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Final Rule to Reform the Requirements for
Long-Term Care Facilities
Karen Tritz – Division of Nursing Homes Director
Clinical Standards Group Long-Term Care Team
Survey & Certification Group Division of Nursing Homes
October 27, 2016
Disclaimer
This presentation was current at the time it was published or
uploaded onto the web. Medicare policy changes frequently so
links to the source documents have been provided within the
document for your reference.
This presentation was prepared as a service to the public and is
not intended to grant rights or impose obligations. This
presentation may contain references or links to statutes,
regulations, or other policy materials. The information provided
is only intended to be a general summary. It is not intended to
take the place of either the written law or regulations. We
encourage readers to review the specific statutes, regulations,
and other interpretive materials for a full and accurate statement
of their contents.
2
Background
• The requirements for Long-Term Care (LTC)
Facilities are the health and safety standards that
LTC facilities must meet in order to participate in
the Medicare or Medicaid Programs.
• The Requirements for Participation are found at 42
CFR 483 Subpart B.
• Additional guidance can be found in the State
Operations Manual, Appendix PP.
4
Changes to LTC Requirements of
Participation
• These requirements have not been
comprehensively updated since 1991 despite
significant changes in the industry.
• The proposed rule received over 9,800 public
comments, resulting in a number of revisions to
the proposed requirements.
• The finalized provisions reflect advances in the
theory and practice of service delivery and safety,
and implement sections of the Affordable Care Act
(ACA).
5
Themes of the Final LTC Rule
• Person-Centered Care
• Quality
• Facility Assessment, Competency-Based Approach
• Alignment with HHS priorities
• Comprehensive Review and Modernization
• Implementation of Legislation
6
Person-Centered Care
Residents and Representatives: Informed, Involved,
and In Control.
• Existing protections maintained
• Choices
• Care & Discharge Planning
• Prohibition on Pre-dispute Arbitration Agreements,
Requirements for Post-Dispute Arbitration Agreements
7
Quality
Quality of Care and Quality of Life--overarching
principles for every service.
Quality of Life and Quality of Care
• Additional special care issues: restraints, pain
management, bowel incontinence, dialysis services,
and trauma-informed care
Quality Assurance and Performance Improvement
• Based on the pilot
• Resources available -
http://www.cms.gov/Medicare/Provider-
Enrollment-and-Certification/QAPI/nhqapi.html
8
Facility Assessment and
Competency-Base Approach
Facilities need to know themselves, their staff,
and their residents.
• Not a one-size fits all approach.
• Accounts for and allows for diversity in
populations and facilities.
• Focus on each resident achieving their highest
practicable physical, mental, and psychosocial
well-being.
9
Align with Current HHS Initiatives
Advancing cross-cutting priorities
• Reducing unnecessary hospital readmissions,
• Reducing the incidences of healthcare acquired
infections,
• Improving behavioral healthcare, and
• Safeguarding nursing home residents from the use of
unnecessary psychotropic (antipsychotic) medications
10
Comprehensive Review and Modernization
Bringing it into the twenty-first century
• Reorganized
• Updated
• Consistent with current health and safety knowledge
11
Implementation of Legislation
• Section 6102(b) of ACA, compliance and ethics
program.
• Section 6102(c) of ACA, quality assurance and
performance improvement program (QAPI).
• Section 6703(b)(3) of the ACA (Section 1150B of the
Act), requirements for reporting to law
enforcement suspicion of crimes.
• Section 6121 of ACA, dementia and abuse training.
• Section 2 of the IMPACT Act (adds 1899B to the
Act), discharge planning requirements for SNFs.
12
Phased In Implementation Schedule
Regulation will be implemented in 3 phases.
• Phase 1: Existing requirements, those requirements relatively
straightforward to implement, and require minor changes to
survey process. (November 28, 2016)
• Phase 2: All Phase 1 requirements, and those that providers
need more time to develop, foundational elements, new survey
process can assess compliance. (November 28, 2017)
• Phase 3: All Phase 1 and 2, those requirements that need more
time to implement (personnel hiring and training,
implementation of systems approaches to quality).
(November 28, 2019)
13
Phased Implementation
14
Phase Primary Implementation
Phase 1
(* this section is partially
implemented in Phase 2
and/or 3)
• Resident Rights and Facility Responsibilities*
• Freedom from Abuse Neglect and Exploitation*
• Admission, Transfer and Discharge*
• Resident Assessment
• Comprehensive, Person-Centered Care Planning*
• Quality of Life
• Quality of Care*
• Physician Services
• Nursing Services*
• Pharmacy Services*
• Laboratory, radiology and other diagnostic services
• Dental Services*
• Food and Nutrition*
• Specialized Rehabilitation
• Administration (Facility Assessment – Phase 2)*
• Quality Assurance and Performance Improvement* - QAA
Committee
• Infection Control – Program*
• Physical Environment*
Phased Implementation (continued)
15
Phase 2 • Behavioral Health Services*
• Quality Assurance and Performance Improvement* - QAPI
Plan
• Infection Control – Facility Assessment and Antibiotic
Stewardship **
• Compliance and Ethics*
• Physical Environment- smoking policies *
Phase 3 • Quality Assurance and Performance Improvement* -
Implementation of QAPI
• Infection Control – Infection Control Preventionist *
• Compliance and Ethics*
• Physical Environment-call lights at resident bedside *
• Training *
*This section is partially implemented in other phases
483.5 Definitions
Added federal definitions
• Clarification of abuse, neglect, exploitation,
mistreatment
• Adverse event (QAPI)
• Nurse aide
• Person-centered
16
483.10 Resident Rights
• Combined section
• Significant existing language
• All Phase 1 changes, except –
• Phase 2 facility providing contact information for
certain organizational units (Aging and Disability
Resource Center, Medicaid Fraud Control Unit
17
483.12 Freedom from Abuse, Neglect,
and Exploitation
18
• Phase 1 - Strengthens existing protections, in addition to review
of policies and procedures. Adds language related to resident
“right to be free from neglect” and “exploitation.”
• Phase 2 - Regulatory inclusion of 1150B requirements (Reporting
reasonable suspicion of a crime). This is an existing requirement
under the Statute.
• Phase 3 - QAPI must be involved in review of
allegations/incidences of abuse, neglect, and exploitation.
483.15 Admission, Transfer, and
Discharge Rights
19
• Strengthens requirements for discharge
planning.
• Phase 1: all sections implemented except:
• (c)(2) Transfer/Discharge Documentation -
Implemented in Phase 2.
483.20 Resident Assessment
• Few changes to resident assessment, but strengthened
PASARR section.
• Implemented in Phase 1.
20
483.21 Comprehensive Person-
Centered Care Planning
21
• Many of requirements maintained - implemented
in Phase 1 except
• Baseline care plan - Implemented in Phase 2.
• (b)(3)(iii) Trauma informed care - Implemented in
Phase 3.
483.24 Quality of Life
22
• No brand new requirements.
• “Highest Practicable Well-Being” language in this
section.
• Implemented Phase 1.
483.25 Quality of Care
23
• Adds special care issues many of which were previously
cited under F309 if there were care issues.
• Specific areas: restraints, pain management, bowel
incontinence, dialysis services, and trauma-informed
care.
• All of this section implemented in Phase 1 except
trauma-informed care (Phase 3).
483.30 Physician Services
24
• Final removed language in proposed rule regarding
physician visit prior to transfer.
• Ability to delegate dietary orders.
• All of this section implemented in Phase 1.
483.35 Nursing Services
25
• Need both sufficient and competent staffing based on
resident population.
• This determination is tied to Facility’s Assessment
(Phase 2).
• Otherwise this section contains many existing
requirements and will be implemented in Phase 1.
483.40 Behavioral Health Services
26
• New requirement (incorporates highest practicable well-being,
specialized rehabilitation, and medical social services)
• Sufficient, competent staff
• Resident with dementia has treatment and services needed to
meet his/her needs
• Implementation on non-pharmacological interventions
• Most in Phase 2. Except- Phase 1: Comprehensive assessment
and medically-related social services
Phase 3: Residents with history of trauma/PTSD
483.45 Pharmacy Services
27
• Protections continued (freedom from unnecessary
medications and medication errors, medication
storage) – Phase 1
• Drug regimen review and reporting – Phase 2- review
of medical chart
• Phase 2: Definition of psychotropic medication
• PRN usage of psychotropic medication – 14 days –
difference between psychotropic and antipsychotic
medications
Other Regulations
28
Minor Changes – Primarily Phase 1.
• §483.50 Laboratory, radiology, and other diagnostic
services (reduce burden – non-physician practitioners
orders).
• §483.55 Dental services. (new requirements for
replacing lost dentures – Phase 2).
• §483.65 Specialized rehabilitative services.
(strengthen PASRR).
483.60 Food and Nutrition Services
29
• Primarily Phase 1
• Continues food and nutrition protections
• Qualified Dietary Staff – sufficient and competent
• Updated education requirements (dietitian and food
service manager- 5 yr current employee, 1 yr new
hire)
• Reasonable efforts to address religious, cultural and
ethnic needs
• Snacks
• Policy regarding use and storage of foods
483.70 Administration
30
• Primarily Phase 1
• Maintains Existing Requirements
• Licensed Nursing Home Administrator
• Facility assessment – Phase 2
• Use of Arbitration (prohibition of pre-dispute, requirements for
post-dispute)
• Full time social worker for 120 beds + /qualifications
• Incorporates recent regulations (facility closure, hospice,
payroll based journal)
483.75 Quality Assurance and
Performance Improvement
31
• Phase 1 - Participation in QAA Committee and
maintain existing QAA requirements
• Phase 2 – QAPI Plan – as required by Affordable Care
Act
• Phase 3 – Full Implementation of QAPI and
integration of Infection Preventionist
483.80 Infection Control
32
Current Requirements – (Phase 1)
• Infection Control Program
• Linens
• Infection Control Preventionist with Specialized
Training (Phase 3)
• Antibiotic Stewardship (Phase 2)
• Flu and Pneumonia Vaccines
483.85 Compliance and Ethics Program
33
Phase 2 and 3 Implementation
• Program must be reasonably capable of reducing the
prospect of criminal, civil, and administrative
violations under the Act and promoting quality of care
and include:
• Appointing a C&E representative for facility and organization
• Enforcing operating standards
• Responding to violations
• Reviewing annually
483.90 Physical Environment
34
• Primarily Phase 1
• Maintains many existing protections:
• Emergency Power
• Two residents to a room for new
construction/reconstruction
• Resident call next to the bed – Phase 3
• Smoking policies – Phase 2
483.95 Training Requirements
35
• Training requirements for all staff, contractors,
volunteers – in Phase 3 except...
• Incorporates training requirements previously found
elsewhere – (required training for nurse aides,
prohibition of abuse and neglect) – Phase 1
• Adds in requirements from Affordable Care Act –
dementia care training – Phase 1
How are we going to implement?
Implementation Timelines
37
Estimated
Implementation Date
Type of Change Details of Change
Phase 1: November 28,
2016
Effective date of
Nursing Home
Requirements for
Participation
New Regulatory
Language will be
uploaded to ASPEN
under current F Tags
Phase 2: November 28,
2017
• F Tag
numbering
• Interpretive
Guidance (IG)
Implement new
survey process
New F Tag numbers
IG Changes
Begin surveying with
the new survey process
What Exactly Does This Mean?
38
For example:
42 CFR §483.999 The facility must provide purple attire
for all residents to wear on Sundays.
(Disclaimer: This is not a real requirement.)
Expected Impact Phase 1
39
F156 (Closest fit in terms of regulatory intent.)
§483.10(b)(1) -- The facility must inform the resident both
orally and in writing in a language that the resident
understands of his or her rights and all rules and regulations
governing resident conduct and responsibilities during the
stay in the facility...
§483.999 The facility must provide purple attire for all
residents to wear on Sundays.
*************************************
Intent/Interpretive Guidance/Survey Process doesn’t
change…
Expected Impact Phase 2
40
F980 (Formerly F156)
§483.XXXXX -- The facility must inform the resident both
orally and in writing in a language that the resident
understands of his or her rights and all rules and
regulations governing resident conduct and
responsibilities during the stay in the facility…
*************************************
Intent/Interpretive Guidance/Survey Process may
change…
Expected Impact Phase 2
41
F981
§483.999 The facility must provide purple attire for all
residents to wear on Sundays.
Intent/Interpretive Guidance - what indicates
compliance (New guidance)
Survey Process changes - How will surveyors be
interviewing residents and making observations?
(New process)
Survey Process Changes
42
Regulatory
Changes
Quality
Indicator
Survey
Data/ Study/
Test
Traditional
New Survey Process
New Survey Protocol
43
• Computer-based
• Two parts
• Sample Selection
• Offsite 70%
• Onsite 30%
• Investigation
Survey Process
44
• New Survey Process starting in Phase 2 - November
28, 2017
• Incorporates New Requirements
• New F-tags Coding System- F540 +
483.75 Quality Assurance and
Performance Improvement
45
• Phase 1 - Participation in QAA Committee and
maintain existing QAA requirements
• Phase 2 – QAPI Plan – as required by Affordable Care
Act
• Phase 3 – Full Implementation of QAPI and
integration of Infection Preventionist
What Training Will Be Available for
Providers?
46
Phase 1: Recorded Webinar – highlighting Phase 1 changes
Tools – Which tags have new language added – mid-
November.
Phase 2: Webinar and National Provider Calls
New Tags, Interpretive Guidance, Survey Process
Submit Questions / Comments
47
NHSurveyDevelopment@cms.hhs.gov
Question & Answer Session
48
Acronyms in this Presentation
49
Acronym / Phrase Term
LTC Long Term Care
CFR Code of Federal Regulations
QAPI Quality Assurance Process Improvement
SNF Skilled Nursing Facility
The Act Social Security Act
PASARR Preadmission Screening And Resident Review
PTSD Post Traumatic Stress Disorder
C & E Compliance and Ethics
ACA Affordable Care Act
HHS Health & Human Services
IMPACT Improving Medicare Post Acute Care Transformations
QAA Quality Assessment and Assurance
ASPEN Automated Survey Processing Environment
IG Investigative Guidance
Evaluate Your Experience
• Please help us continue to improve the MLN
Connects® National Provider Call Program by
providing your feedback about today’s call.
• To complete the evaluation, visit
http://npc.blhtech.com and select the title for
today’s call.
50
Thank You
• For more information about the MLN Connects®
National Provider Call Program, please visit https://
www.cms.gov/Outreach-and-Education/Outreach/
NPC/National-Provider-Calls-and-Events.html.
• For more information about the Medicare Learning
Network®, please visit https://www.cms.gov/
Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNGenInfo/Index.html.
The Medicare Learning Network® and MLN Connects® are registered trademarks of the U.S.
Department of Health and Human Services (HHS).
51

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CMS: Long-Term Care Regulations Phase 1-3 (Released 10/2016)

  • 1. Final Rule to Reform the Requirements for Long-Term Care Facilities Karen Tritz – Division of Nursing Homes Director Clinical Standards Group Long-Term Care Team Survey & Certification Group Division of Nursing Homes October 27, 2016
  • 2. Disclaimer This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. 2
  • 3. Background • The requirements for Long-Term Care (LTC) Facilities are the health and safety standards that LTC facilities must meet in order to participate in the Medicare or Medicaid Programs. • The Requirements for Participation are found at 42 CFR 483 Subpart B. • Additional guidance can be found in the State Operations Manual, Appendix PP. 4
  • 4. Changes to LTC Requirements of Participation • These requirements have not been comprehensively updated since 1991 despite significant changes in the industry. • The proposed rule received over 9,800 public comments, resulting in a number of revisions to the proposed requirements. • The finalized provisions reflect advances in the theory and practice of service delivery and safety, and implement sections of the Affordable Care Act (ACA). 5
  • 5. Themes of the Final LTC Rule • Person-Centered Care • Quality • Facility Assessment, Competency-Based Approach • Alignment with HHS priorities • Comprehensive Review and Modernization • Implementation of Legislation 6
  • 6. Person-Centered Care Residents and Representatives: Informed, Involved, and In Control. • Existing protections maintained • Choices • Care & Discharge Planning • Prohibition on Pre-dispute Arbitration Agreements, Requirements for Post-Dispute Arbitration Agreements 7
  • 7. Quality Quality of Care and Quality of Life--overarching principles for every service. Quality of Life and Quality of Care • Additional special care issues: restraints, pain management, bowel incontinence, dialysis services, and trauma-informed care Quality Assurance and Performance Improvement • Based on the pilot • Resources available - http://www.cms.gov/Medicare/Provider- Enrollment-and-Certification/QAPI/nhqapi.html 8
  • 8. Facility Assessment and Competency-Base Approach Facilities need to know themselves, their staff, and their residents. • Not a one-size fits all approach. • Accounts for and allows for diversity in populations and facilities. • Focus on each resident achieving their highest practicable physical, mental, and psychosocial well-being. 9
  • 9. Align with Current HHS Initiatives Advancing cross-cutting priorities • Reducing unnecessary hospital readmissions, • Reducing the incidences of healthcare acquired infections, • Improving behavioral healthcare, and • Safeguarding nursing home residents from the use of unnecessary psychotropic (antipsychotic) medications 10
  • 10. Comprehensive Review and Modernization Bringing it into the twenty-first century • Reorganized • Updated • Consistent with current health and safety knowledge 11
  • 11. Implementation of Legislation • Section 6102(b) of ACA, compliance and ethics program. • Section 6102(c) of ACA, quality assurance and performance improvement program (QAPI). • Section 6703(b)(3) of the ACA (Section 1150B of the Act), requirements for reporting to law enforcement suspicion of crimes. • Section 6121 of ACA, dementia and abuse training. • Section 2 of the IMPACT Act (adds 1899B to the Act), discharge planning requirements for SNFs. 12
  • 12. Phased In Implementation Schedule Regulation will be implemented in 3 phases. • Phase 1: Existing requirements, those requirements relatively straightforward to implement, and require minor changes to survey process. (November 28, 2016) • Phase 2: All Phase 1 requirements, and those that providers need more time to develop, foundational elements, new survey process can assess compliance. (November 28, 2017) • Phase 3: All Phase 1 and 2, those requirements that need more time to implement (personnel hiring and training, implementation of systems approaches to quality). (November 28, 2019) 13
  • 13. Phased Implementation 14 Phase Primary Implementation Phase 1 (* this section is partially implemented in Phase 2 and/or 3) • Resident Rights and Facility Responsibilities* • Freedom from Abuse Neglect and Exploitation* • Admission, Transfer and Discharge* • Resident Assessment • Comprehensive, Person-Centered Care Planning* • Quality of Life • Quality of Care* • Physician Services • Nursing Services* • Pharmacy Services* • Laboratory, radiology and other diagnostic services • Dental Services* • Food and Nutrition* • Specialized Rehabilitation • Administration (Facility Assessment – Phase 2)* • Quality Assurance and Performance Improvement* - QAA Committee • Infection Control – Program* • Physical Environment*
  • 14. Phased Implementation (continued) 15 Phase 2 • Behavioral Health Services* • Quality Assurance and Performance Improvement* - QAPI Plan • Infection Control – Facility Assessment and Antibiotic Stewardship ** • Compliance and Ethics* • Physical Environment- smoking policies * Phase 3 • Quality Assurance and Performance Improvement* - Implementation of QAPI • Infection Control – Infection Control Preventionist * • Compliance and Ethics* • Physical Environment-call lights at resident bedside * • Training * *This section is partially implemented in other phases
  • 15. 483.5 Definitions Added federal definitions • Clarification of abuse, neglect, exploitation, mistreatment • Adverse event (QAPI) • Nurse aide • Person-centered 16
  • 16. 483.10 Resident Rights • Combined section • Significant existing language • All Phase 1 changes, except – • Phase 2 facility providing contact information for certain organizational units (Aging and Disability Resource Center, Medicaid Fraud Control Unit 17
  • 17. 483.12 Freedom from Abuse, Neglect, and Exploitation 18 • Phase 1 - Strengthens existing protections, in addition to review of policies and procedures. Adds language related to resident “right to be free from neglect” and “exploitation.” • Phase 2 - Regulatory inclusion of 1150B requirements (Reporting reasonable suspicion of a crime). This is an existing requirement under the Statute. • Phase 3 - QAPI must be involved in review of allegations/incidences of abuse, neglect, and exploitation.
  • 18. 483.15 Admission, Transfer, and Discharge Rights 19 • Strengthens requirements for discharge planning. • Phase 1: all sections implemented except: • (c)(2) Transfer/Discharge Documentation - Implemented in Phase 2.
  • 19. 483.20 Resident Assessment • Few changes to resident assessment, but strengthened PASARR section. • Implemented in Phase 1. 20
  • 20. 483.21 Comprehensive Person- Centered Care Planning 21 • Many of requirements maintained - implemented in Phase 1 except • Baseline care plan - Implemented in Phase 2. • (b)(3)(iii) Trauma informed care - Implemented in Phase 3.
  • 21. 483.24 Quality of Life 22 • No brand new requirements. • “Highest Practicable Well-Being” language in this section. • Implemented Phase 1.
  • 22. 483.25 Quality of Care 23 • Adds special care issues many of which were previously cited under F309 if there were care issues. • Specific areas: restraints, pain management, bowel incontinence, dialysis services, and trauma-informed care. • All of this section implemented in Phase 1 except trauma-informed care (Phase 3).
  • 23. 483.30 Physician Services 24 • Final removed language in proposed rule regarding physician visit prior to transfer. • Ability to delegate dietary orders. • All of this section implemented in Phase 1.
  • 24. 483.35 Nursing Services 25 • Need both sufficient and competent staffing based on resident population. • This determination is tied to Facility’s Assessment (Phase 2). • Otherwise this section contains many existing requirements and will be implemented in Phase 1.
  • 25. 483.40 Behavioral Health Services 26 • New requirement (incorporates highest practicable well-being, specialized rehabilitation, and medical social services) • Sufficient, competent staff • Resident with dementia has treatment and services needed to meet his/her needs • Implementation on non-pharmacological interventions • Most in Phase 2. Except- Phase 1: Comprehensive assessment and medically-related social services Phase 3: Residents with history of trauma/PTSD
  • 26. 483.45 Pharmacy Services 27 • Protections continued (freedom from unnecessary medications and medication errors, medication storage) – Phase 1 • Drug regimen review and reporting – Phase 2- review of medical chart • Phase 2: Definition of psychotropic medication • PRN usage of psychotropic medication – 14 days – difference between psychotropic and antipsychotic medications
  • 27. Other Regulations 28 Minor Changes – Primarily Phase 1. • §483.50 Laboratory, radiology, and other diagnostic services (reduce burden – non-physician practitioners orders). • §483.55 Dental services. (new requirements for replacing lost dentures – Phase 2). • §483.65 Specialized rehabilitative services. (strengthen PASRR).
  • 28. 483.60 Food and Nutrition Services 29 • Primarily Phase 1 • Continues food and nutrition protections • Qualified Dietary Staff – sufficient and competent • Updated education requirements (dietitian and food service manager- 5 yr current employee, 1 yr new hire) • Reasonable efforts to address religious, cultural and ethnic needs • Snacks • Policy regarding use and storage of foods
  • 29. 483.70 Administration 30 • Primarily Phase 1 • Maintains Existing Requirements • Licensed Nursing Home Administrator • Facility assessment – Phase 2 • Use of Arbitration (prohibition of pre-dispute, requirements for post-dispute) • Full time social worker for 120 beds + /qualifications • Incorporates recent regulations (facility closure, hospice, payroll based journal)
  • 30. 483.75 Quality Assurance and Performance Improvement 31 • Phase 1 - Participation in QAA Committee and maintain existing QAA requirements • Phase 2 – QAPI Plan – as required by Affordable Care Act • Phase 3 – Full Implementation of QAPI and integration of Infection Preventionist
  • 31. 483.80 Infection Control 32 Current Requirements – (Phase 1) • Infection Control Program • Linens • Infection Control Preventionist with Specialized Training (Phase 3) • Antibiotic Stewardship (Phase 2) • Flu and Pneumonia Vaccines
  • 32. 483.85 Compliance and Ethics Program 33 Phase 2 and 3 Implementation • Program must be reasonably capable of reducing the prospect of criminal, civil, and administrative violations under the Act and promoting quality of care and include: • Appointing a C&E representative for facility and organization • Enforcing operating standards • Responding to violations • Reviewing annually
  • 33. 483.90 Physical Environment 34 • Primarily Phase 1 • Maintains many existing protections: • Emergency Power • Two residents to a room for new construction/reconstruction • Resident call next to the bed – Phase 3 • Smoking policies – Phase 2
  • 34. 483.95 Training Requirements 35 • Training requirements for all staff, contractors, volunteers – in Phase 3 except... • Incorporates training requirements previously found elsewhere – (required training for nurse aides, prohibition of abuse and neglect) – Phase 1 • Adds in requirements from Affordable Care Act – dementia care training – Phase 1
  • 35. How are we going to implement?
  • 36. Implementation Timelines 37 Estimated Implementation Date Type of Change Details of Change Phase 1: November 28, 2016 Effective date of Nursing Home Requirements for Participation New Regulatory Language will be uploaded to ASPEN under current F Tags Phase 2: November 28, 2017 • F Tag numbering • Interpretive Guidance (IG) Implement new survey process New F Tag numbers IG Changes Begin surveying with the new survey process
  • 37. What Exactly Does This Mean? 38 For example: 42 CFR §483.999 The facility must provide purple attire for all residents to wear on Sundays. (Disclaimer: This is not a real requirement.)
  • 38. Expected Impact Phase 1 39 F156 (Closest fit in terms of regulatory intent.) §483.10(b)(1) -- The facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility... §483.999 The facility must provide purple attire for all residents to wear on Sundays. ************************************* Intent/Interpretive Guidance/Survey Process doesn’t change…
  • 39. Expected Impact Phase 2 40 F980 (Formerly F156) §483.XXXXX -- The facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and all rules and regulations governing resident conduct and responsibilities during the stay in the facility… ************************************* Intent/Interpretive Guidance/Survey Process may change…
  • 40. Expected Impact Phase 2 41 F981 §483.999 The facility must provide purple attire for all residents to wear on Sundays. Intent/Interpretive Guidance - what indicates compliance (New guidance) Survey Process changes - How will surveyors be interviewing residents and making observations? (New process)
  • 42. New Survey Protocol 43 • Computer-based • Two parts • Sample Selection • Offsite 70% • Onsite 30% • Investigation
  • 43. Survey Process 44 • New Survey Process starting in Phase 2 - November 28, 2017 • Incorporates New Requirements • New F-tags Coding System- F540 +
  • 44. 483.75 Quality Assurance and Performance Improvement 45 • Phase 1 - Participation in QAA Committee and maintain existing QAA requirements • Phase 2 – QAPI Plan – as required by Affordable Care Act • Phase 3 – Full Implementation of QAPI and integration of Infection Preventionist
  • 45. What Training Will Be Available for Providers? 46 Phase 1: Recorded Webinar – highlighting Phase 1 changes Tools – Which tags have new language added – mid- November. Phase 2: Webinar and National Provider Calls New Tags, Interpretive Guidance, Survey Process
  • 46. Submit Questions / Comments 47 NHSurveyDevelopment@cms.hhs.gov
  • 47. Question & Answer Session 48
  • 48. Acronyms in this Presentation 49 Acronym / Phrase Term LTC Long Term Care CFR Code of Federal Regulations QAPI Quality Assurance Process Improvement SNF Skilled Nursing Facility The Act Social Security Act PASARR Preadmission Screening And Resident Review PTSD Post Traumatic Stress Disorder C & E Compliance and Ethics ACA Affordable Care Act HHS Health & Human Services IMPACT Improving Medicare Post Acute Care Transformations QAA Quality Assessment and Assurance ASPEN Automated Survey Processing Environment IG Investigative Guidance
  • 49. Evaluate Your Experience • Please help us continue to improve the MLN Connects® National Provider Call Program by providing your feedback about today’s call. • To complete the evaluation, visit http://npc.blhtech.com and select the title for today’s call. 50
  • 50. Thank You • For more information about the MLN Connects® National Provider Call Program, please visit https:// www.cms.gov/Outreach-and-Education/Outreach/ NPC/National-Provider-Calls-and-Events.html. • For more information about the Medicare Learning Network®, please visit https://www.cms.gov/ Outreach-and-Education/Medicare-Learning- Network-MLN/MLNGenInfo/Index.html. The Medicare Learning Network® and MLN Connects® are registered trademarks of the U.S. Department of Health and Human Services (HHS). 51