Industry Insights

Proposed Rule Revamps Long-Term Care Regulations

July 2015
Author:  Suzy Harvey

Suzy Harvey

Managing Consultant


Health Care

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)


On July 16, 2015, the Department of Health and Human Services (HHS) released a proposed rule, Medicare and Medicaid Programs:  Reform of Requirements for Long-Term Care Facilities. The proposed rule is one of the most ambitious and comprehensive changes to the Requirements of Participation since the Omnibus Budget Reconciliation Act of 1987.  

The proposed rule has redesigned, revised or relocated every federal regulation in Appendix PP of the State Operations Manual. Table A of the proposed rule is a detailed walkthrough of all changes to the manual. 

Seven new sections have been added, and some have incorporated requirements from revised sections. The new sections are:

  • Facility Responsibilities (§483.11)
  • Comprehensive Person-Centered Care Planning (§483.21)
  • Behavioral Health Services (§483.40)
  • Laboratory, Radiology and Other Diagnostic Services (§438.50)
  • Quality Assurance and Performance Improvement (QAPI) (§483.75)
  • Compliance and Ethics Program (§483.85)
  • Training Requirements (§438.95)

These seven sections also include requirements set forth in the Patient Protection and Affordable Care Act (ACA) concerning training requirements related to dementia and abuse prevention, reporting suspected crime to law enforcement, establishing a compliance and ethics program and QAPI. 

Definitions have been added and expanded and language modified, as some terminology is outdated. Some language has been updated to improve logical order and readability or clarify aspects of the regulations and updated for advances in technology, such as electronic communications.  

The proposed rule says these changes will reduce procedural burdens on providers while achieving “broad-based improvements in the quality of health care and patient safety.”

For providers, implementing the changes addressed in the proposed rule could be costly, not only in labor hours spent reviewing and revising facility policies and procedures but in educating, training and hiring staff to comply with new regulations.

The Centers for Medicare & Medicaid Services estimates the total projected cost of implementing the rule will be $729 million in the first year and $636 million per year in subsequent years; this equates to roughly $46,000 per facility.

While nursing facilities have implemented some of the changes in response to the ACA and Improving Medicare Post-Acute Care Transformation Act of 2014, all providers should carefully and thoroughly review the proposed rule. Providers have until September 14, 2015, to make comments or recommendations for changes or amendments. Electronic comments can be submitted at

Contact your BKD advisor if you have questions or need assistance.

BKD LinkedIn BKD Twitter BKD Youtube BKD Google Plus