On November 28, 2017, the second phase of a three-part implementation of the Centers for Medicare and Medicaid Services’ (CMS) Final Rule went into effect, revising certain participation requirements for Long Term Care (LTC) facilities. The original CMS Final Rule that became effective in November 2016 had already marked a major change to participation and survey requirements for skilled nursing facilities (SNF) and nursing facilities (NF). This second phase only continues to add complex compliance requirements for LTC facilities.
Specifically, the second phase includes additional key survey procedures and surveyor guidelines of which LTC facilities should be aware. For example, the new guidelines require a baseline care plan be completed within 48 hours after admission, and gives residents increased choice over who participates with them on the interdisciplinary team that develops the comprehensive care plan. Additionally, revisions have been made to standard practices relating to behavioral health services, standard of care for transfers and charges, and facility assessments, among others.
To address concerns regarding the scope and timing of the revised requirements, CMS has agreed to allow LTC providers 18 months to adapt to certain requirements without facing enforcement penalties. The overall implementation, however, did not change, and providers are still expected to be ready for the new survey process and to comply with the requirements that were not affected by the 18-month moratorium. The moratorium does apply to a few “unique and separate” F-Tags, such that LTCs will still be cited by surveyors for non-compliance, but will not be financially penalized in an effort to allow the facilities time to appropriately adapt to the changes. The F-Tags included in the moratorium are:
- F-655 – Baseline Care Plan
- F-740 – Behavioral Health Services
- F-741 – Sufficient/Competent Direct Care/Access Staff-Behavioral Health
- F-758 – Psychotropic Medications related to PRN Limitations
- F-838 – Facility Assessment
- F-881 – Antibiotic Stewardship Program
- F-865 – QAPI Program and Plan related to the development of the QAPI Plan
- F-926 – Smoking Policies
The revision of CMS’s requirements for LTC facilities demonstrates a push to improve current quality of care and service delivery practices utilized in nursing facilities, especially in light of the increasing complexity of health concerns of individuals residing in LTC facilities. It is imperative for nursing home providers to have their facilities compliant with the new participation and survey requirements.
Contact Frier Levitt today for help making your nursing facility compliant with the changes in CMS’s survey process or for assistance with understanding the expectations under the revised requirements for participation and how such expectations may impact your business.
