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Update: Federal Requirements for Long-Term Care (LTC) Facilities Notice of Facility Closure

The Centers for Medicare & Medicaid (CMS) has provided the final rule for long term care facilities that plan on closing, which will go into effect on April 18, 2013. An interim rule was provided in February of 2011 with an effective date of March 23, 2011 and this revision creates the final language. As a skilled nursing facility administrator, here’s what you need to know, since much of the burden is placed on you.

  • The Federal Register Vol. 78, No. 53 provides information on this final rule, which requires a facility’s administrator to provide written notification of closure at least 60 days prior to the anticipated closure date of the facility. If the Secretary terminates Medicare or Medicaid program participation, then the administrator must provide notice of closure by the date the Secretary has provided.
    • Written notification must be provided to the State Survey Agency and the State LTC Ombudsman, as well as all residents and their families or legal representatives.
    •  It is noted that some States may have more stringent requirements for providing notification closure, and in those cases, that State’s requirement should be followed.
    • No new residents may be admitted after written notice is submitted to the above mentioned parties.
  • In addition to providing the written notification of the closure, a closure plan that includes information the transfer and relocation of residents must be submitted and approved by the State. CMS notes that the burden for closing the facility is on the State, so that is the agency responsible for approval.
    • The closure plan provides the facility with a roadmap to ensure the residents’ health and safety is protected. The SOM will be revised to include information that “the residents would be transferred to the most appropriate facility or other setting in terms of quality, services and location, taking into consideration the needs, choice and best interest of each resident.
    • If admission to a desired facility is denied, the closing facility would bear the burden of locating another facility that meets the resident’s requirements.
  • Plans for relocating the residents should ensure that their families or legal representatives are involved as much as possible and that a proper discharge summary is provided for each resident.  The staff should also be provided education on discharges and transfers so there is minimal impact on the resident.
  • Policies and Procedures must be put in place regarding the administrator’s duties when planning to close the nursing home as well as throughout the process. Noncompliance can be assessed during survey and deficiencies can be cited.
    • An administrator who is not immediately made aware of the closure plans or who is hired just to assist with the closing procedure is responsible from the time he is made aware until the facility is shut down. An appeals process has been added into the regulation in case a hearing is required.

The intent of this rule is to help ensure that the transition is smooth as possible for residents, their families and staff members. Since administrators will be required to provide sufficient notice and information regarding the closing, it should create improved care coordination between the closing facility and the new ones the residents will be transferred to.  Keep in mind the emphasis CMS has placed on resident choices, rights and safety when you are developing your closure plan.