The Centers for Medicare & Medicaid Services (CMS) unveiled 713 pages of regulations last fall that affect long-term care workers. The regulations appeared a few months before the first official survey due date of November 28, 2016, when Phase I was to be surveyed as completed, or at least well initiated in nursing homes. CMS estimated compliance with the new rules would cost the provider an average of $62,900 in the first year and then $55,000 per facility per year. Most of the cost will enhance the facility’s infection control, resident rights and compliance, ethics and quality assurance programs.
Fortunately, these regulations have been discussed for some time. Your facility already may have many of these required systems in place. A main focus of the mandates is for facilities to offer person-centered care with more emphasis on a facility’s Quality Assurance and Performance Improvement (QAPI) program. These new QAPI requirements are now required to be shared with the state survey team within one year of this regulation (November 28, 2017). Long-term care facility personnel must complete a “baseline care plan” within 48 hours of a resident’s admission to include the minimum health care information for proper care. If the plan is thorough enough, it may count as the comprehensive care plan. Surveyors will be looking for specific changes or additions in facilities such as these resident care plans.
For some time, a care plan team would invite the resident/patient, pertinent family or friends—if the resident chooses—and pertinent staff members. There’s now an expectation that the plan’s development will involve direct caregivers, dietary staff members aware of the resident’s food preferences, the social worker, etc. The plans should be life stories with the resident/patient being central. The plan should detail individuals’ likes and dislikes, such as when they like to wake up and whether they want to select their own clothing. Are there any important religious or cultural aspects about that person? What are the resident’s goals, and how’s the facility helping the resident achieve them? What specific interventions are helping? There should be discharge planning unless the patient/resident plans to remain in the facility. The plans have become much more specific.
New regulations allow qualified dietary and therapy professionals permitted by law to write orders. The physician must first authorize it and then the state law allow it.
There’s still controversy with prohibiting predispute binding arbitration. The American Health Care Association has sued the federal government, contending patients and their families should still be required to settle any dispute over care outside the court system through arbitration. The suit asks a federal court to at least delay the ban while the court hears testimony from the industry.
Staff must be skilled and competent. The facility’s infection control policies and procedures must be updated to enhance prevention using an antibiotic stewardship program that should include protocols and a monitoring system for antibiotics (due in Phase II – November 28, 2017).
Many terms have been added or changed in the new regulations, such as new definitions for abuse, neglect, exploitation, misappropriation, resident representative and person-centered care. Family member and legal representative are replaced with the term “resident representative.” CMS says the facility no longer needs to credential the physician. Definition changes will alter policy, resulting in potentially deficient practices. Management needs to review all manuals, policies and contracts.
Facilities are required to perform a self-assessment evaluation that considers resident/patient numbers, acuity, diagnoses, behaviors, etc., and determine if they have sufficient nursing staff and competencies that match their population.
Pharmacists must now report certain events to the attending physician, director of nursing and medical director. It imposes limits on PRN orders for psychotropic drugs.
Facilities cannot charge the resident or family for lost or damaged dentures when the facilities were at fault. Referrals for these dentures must occur within three business days. Facilities must follow some specific preadmission screen and resident review requirements. Each facility must develop a compliance and ethics program (due in Phase III – November 28, 2019) to prevent and detect civil, criminal and administrative violations. There’s also a change in civil penalty charges. According to a recent McKnight’s article, the U.S. Department of Health & Human Services announced that inflation caused the maximum penalties for providers to increase from $10,000 to $20,628 a day for noncompliance in a skilled nursing facility.
CMS officials have said they’ll work with providers who make honest attempts to initiate the regulations according to Phase I, II and III timelines. They’ve said their goals are provider goals in bringing higher quality care to our nation’s seniors. When working with your team to develop workable systems within your facilities, remember BKD’s skilled consultants with years of facility management experience can help.